Circulatory Management and Acute Kidney Injury in Patients Undergoing Partial Nephrectomy
- Conditions
- Acute Kidney Injury
- Interventions
- Other: Goal-directed circulatory managementOther: Routine circulatory management
- Registration Number
- NCT02803372
- Lead Sponsor
- Peking University First Hospital
- Brief Summary
The purpose of this study is to investigate whether circulatory management based on LiDCOrapid hemodynamic monitoring can reduce the incidence of acute kidney injury in patients undergoing partial nephrectomy when compared with routine circulatory management based on blood pressure and urine output monitoring
- Detailed Description
Previous studies found that the incidence of acute kidney injury afer partial nephrectomy is higher than 30%. In addition to nephron loss induced by renal parenchyma resection, ischemia/reperfusion injury produced by clamping/unclamping of renal arteries is also an important reason. However, studies investigating the effect of circulatory management on the incidence of acute kidney injury after partial nephrectomy are limited.
It has been shown that perioperative hemodynamic optimization protected renal function in surgical patients. And in patients undergoing renal transplantation, adequate hydration and optimal perfusion enhances early graft function. The investigators hypothesize that hydration and circulatory management to guarantee optimal renal perfusion may decrease the occurrence of acute kidney injury after partial nephrectomy. The purpose of this study is to investigate whether circulatory management based on LiDCOrapid hemodynamic monitoring can reduce the incidence of acute kidney injury in patients undergoing partial nephrectomy when compared with routine circulatory management based on blood pressure and urine output monitoring.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 144
- Age > 18 years;
- Planning to undergo partial nephrectomy;
- Patients with renal function damage (chronic kidney disease stage 3-5) before surgery;
- Patients with arrhythmia or aortic valve diseases (moderate or higher degree stenosis/regurgitation);
- Patients who has participated in other trials.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention group Goal-directed circulatory management In addition to routine monitoring, invasive LiDCOrapid is used to monitor mean arterial pressure (MAP), stroke volume variation (SVV) and cardiac index (CI). Intraoperative goal-directed circulatory management is performed, i.e., to maintain MAP \> 95 mmHg, SVV \< 6%, and CI 3.0-4.0 L/min/m2, started from renal artery clamping and maintained until the end of surgery. Control group Routine circulatory management Routine monitoring is performed, which includes invasive blood pressure and urine output. Intraoperative routine circulatory management is performed, i.e., to maintain blood pressure within 20% from baseline level and urine output \> 0.5 ml/kg/h.
- Primary Outcome Measures
Name Time Method Incidence of acute kidney injury after surgery During the first 3 days after surgery Acute kidney injury is diagnosed according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria
- Secondary Outcome Measures
Name Time Method Serum creatinine concentration At 3 and 6 months after surgery Serum creatinine concentration
Length of stay in hospital after surgery From end of surgery to 30 days after surgery Length of stay in hospital after surgery
Incidence of postoperative complications From end of surgery to 30 days after surgery Incidence of complications within 30 days after surgery
Trial Locations
- Locations (1)
Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital
🇨🇳Beijing, Beijing, China