Influencia de la albúmina asociada a la cirugía cardiaca bajo circulación extracorpórea

Abstract

BACKGROUND Acute kidney injury following cardiopulmonary bypass affects up to 40% patients, being an important risk factor of morbidity and mortality. Albumin has been used as a part of the priming solution of the cardiopulmonary bypass circuit. We aimed to analyze the effect of the human albumin administered during cardiopulmonary bypass on the incidence of acute kidney injury according to the KDIGO scale during the first 5 days after the surgery. We mainly hypothesize that the use of albumin will decrease renal dysfunction and, as a result, improve survival, length of ICU stays and economic costs. METHODS We performed a single-center, randomized, double-blinded controlled trial. Patients with glomerular filtration rate > 60 ml/min/1,73 m2 proposed to cardiac surgery using cardiopulmonary bypass were enrolled. Two groups were defined according to the priming solution in the extracorporeal circulation circuit: the intervention group with Albumin 4% in a crystalloid solution (Plasmalyte) (n= 126); and the control group with crystalloid solution (Plasmalyte)(n=122). We reported the proportion of kidney disfunction development during the first 5 days.The study was registered in the database of the United States National Health Service (ClinicalTrials.gov), registration number NCT03373318. RESULTS We obtained no differences in the proportion of acute kidney injury during the first 5 days between two groups: in the intervention group was 29.37% (95% IC: 21.41- 37.31%) and in the control group was 31.15% (95% IC: 22.93- 39.36%), p value= 0.760. However, the difference increased in favor of albumin (57.58% versus 35.71%, p value= 0.059) if we analyze the subgroup with a glomerular filtration rate between 60 and 70 mL/min. CONCLUSIONS The results showed that albumin didn't decrease the acute kidney injury following cardiac surgery in patients without previous renal dysfunction. It was also not associated with a reduction in ICU stay, incidence of complications or mortality.

Date of Award	4 Jun 2021
Original language	Spanish
Supervisor	Antonio Jorge Betbese Roig (Director), Maria Mercedes Garcia Alvarez (Director), Maria Pilar Paniagua Iglesias (Director) & Xavier León i Vintró (Director)