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A new approach for the prevention of acute kidney injury in on-pump cardiac surgery

Heyman Luckraz, Ramesh Giri, and Benjamin Wrigley

Purpose: Cardiac Surgery Associated Acute Kidney Injury (CSA-AKI) is linked to significant patient morbidity and mortality. We assessed the use of instantaneous balanced forced diuresis provided by the RenalGuard® (RG) system in the perioperative phase and its impact on CSA-AKI.

Description: From September 2015 to June 2019, the RG system was used in 120 patients at high risk of CSA-AKI. The first 10 patients were studied as part of a device evaluation exercise, followed by a randomized study comparing the use of RG (110 patients) versus standard practice (110 patients). The balanced forced diuresis was started at induction of anesthesia, continued throughout surgery, and up to six hours post-admission on the CICU.

Evaluation: The RG system reduced CSA-AKI rates significantly without impacting the post-operative rates of atrial fibrillation, blood transfusion, and infection. Patients on the RG system produced 3 liters-5 liters of urine intra-operatively and required a higher dose of potassium supplementation (median dose 60 mmol vs. 30 mmol)

Conclusions: CSA-AKI rate is lowered by the RG system. Further studies are required to assess cost-benefit.