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. 2019 Oct;7(20):534.
doi: 10.21037/atm.2019.09.140.

Preemptive renal replacement therapy in post-cardiotomy cardiogenic shock patients: a historically controlled cohort study

Guo-Wei Tu  1 , Jia-Rui Xu  2 , Lan Liu  1 , Du-Ming Zhu  1 , Xiao-Mei Yang  1 , Chun-Sheng Wang  3 , Guo-Guang Ma  1 , Zhe Luo  1   4 , Xiao-Qiang Ding  2
Affiliations

Preemptive renal replacement therapy in post-cardiotomy cardiogenic shock patients: a historically controlled cohort study

Guo-Wei Tu et al. Ann Transl Med. 2019 Oct.

Abstract

Background: The aim of the study was to evaluate whether the preemptive renal replacement therapy (RRT) might improve outcomes in post-cardiotomy cardiogenic shock (PCCS) patients.

Methods: In Period A (September 2014-April 2016), patients with PCCS received RRT, depending on conventional indications or bedside attendings. In Period B (May 2016-November 2017), the preemptive RRT strategy was implemented in all PCCS patients in our intensive care unit. The goal-directed RRT was applied for the RRT patients. The hospital mortality and renal recovery were compared between the two periods.

Results: A total of 155 patients (76 patients in Period A and 79 patients in Period B) were ultimately enrolled in this study. There were no significant differences in demographic characteristics and intraoperative and postoperative parameters between the two groups. The duration between surgery and RRT initiation was significantly shorter in Period B than in Period A [23 (17, 66) vs. 47 (20, 127) h, P<0.01]. The hospital mortality in Period B was significantly lower than that in Period A (38.0% vs. 59.2%, P<0.01). There were fewer patients with no renal recovery in Period B (4.1% vs. 19.4%, P=0.026). Patients in Period B displayed a significantly shorter time to completely renal recovery (12±15 vs. 25±15 d, P<0.05).

Conclusions: Among PCCS patients, preemptive RRT compared with conventional initiation of RRT reduced mortality in hospital and also led to faster and more frequent recovery of renal function. Our preliminary study supposed that preemptive initiation of RRT might be an effective approach to PCCS with acute kidney injury (AKI).

Keywords: Renal replacement therapy (RRT); acute kidney injury (AKI); cardiac surgery; cardiogenic shock (CS); timing.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the study. PCCS, post-cardiotomy cardiogenic shock; RRT, renal replacement therapy; ESRD, end-stage renal disease.
Figure 2
Figure 2
Evolution of hemodynamic parameters over time. Error bars are standard deviation. The asterisk (*) and the blue triangle indicate P<0.05, compared with 0 h. MAP, mean artery pressure; CVP, central venous pressure.
Figure 3
Figure 3
Kaplan-Meier curves for in-hospital mortality.
Figure S1
Figure S1
Evolution of hemodynamic parameters over time in survivors. The asterisk (*) and the blue triangle indicate P<0.05, compared with 0 h.
Figure S2
Figure S2
Evolution of hemodynamic parameters over time in non-survivors. The asterisk (*) and the blue triangle indicate P<0.05, compared with 0 h.
See this image and copyright information in PMC

Comment in

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