Abstract
ObjectivesForced‐diuresis during cardiopulmonary bypass (CPB) can be associated with significant electrolyte shifts. This study reports on the serum electrolyte changes during balanced forced‐diuresis with the RenalGuard® system (RG) during CPB.MethodsPatients at risk of acute kidney injury (AKI)—(history of diabetes &/or anaemia, e‐GFR 20–60 ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore >5)—were randomized to either RG (study group) or managed as per current practice (control group).ResultsThe use of RG reduced AKI rate (10% for RG and 20.9% in control, p = .03). Mean urine output was significantly higher in the RG group during surgery (2366 ± 877 ml vs. 765 ± 549 ml, p < .001). The serum potassium levels were maintained between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for the controls. Median potassium supplemental dose was 60 (0–220) mmol (RG group) as compared to 30 (0–190) mmol for control group over first 24 h (p < .001). On Day 1 post‐op, there were no significant differences in the serum sodium, potassium, calcium, magnesium, phosphate, and chloride levels between the two groups. Otherwise, postoperative clinical recovery was also similar.ConclusionsBalanced forced‐diuresis with the RG reduced AKI rates after on‐pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.
Highlights
It is a closed‐loop fluid management system which allows forced‐diuresis to be induced with low dose (0.25–0.5 mg/Kg) furosemide while inadvertent volume depletion is prevented by the administration of intravenous (i.v) fluids at a rate which can be matched in real‐time to the urine output
The primary outcome of postoperative acute kidney injury (AKI) was significantly lower in the RenalGuard® system (RG) group as compared to controls (10% vs. 20.9%, p = .025)
The secondary aims of mean volumes of urine produced during surgery (2366 ± 877 ml vs. 765 ± 549 ml) and within first 24‐h post‐ op on cardiac intensive care unit (CICU) (3310 ± 1303 ml vs. 2052 ± 804 ml) were significantly higher in RG group (p < .001)
Summary
The principles and components of RG have been extensively described in previous reports.[4,5] In brief, it is a closed‐loop fluid management system which allows forced‐diuresis to be induced with low dose (0.25–0.5 mg/Kg) furosemide while inadvertent volume depletion is prevented by the administration of intravenous (i.v) fluids at a rate which can be matched in real‐time to the urine output. Its components include a high‐volume fluid pump, a high‐accuracy dual weight measuring system, a single‐use i.v set and a urine collection system that interfaces with standard Foley urinary catheter. The RG console measures the volume of urine in the collecting set, calculates urine flow rate and infuses a pre‐set volume of hydration fluid to match the urine output, as decided by the treating physician. The console allows the user to set either an overall equal fluid balance (zero balance) or a net fluid gain above or loss below matched hydration as well as allowing the user to infuse fluid boluses
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