title: A Single-Center Randomized Trial of Intraoperative Zero-Balanced Ultrafiltration During Cardiopulmonary Bypass for Patients With Impaired Kidney Function Undergoing Cardiac Surgery.
abstract: OBJECTIVE
  The authors investigated whether zero-balance ultrafiltration (Z-BUF) during bypass significantly improves clinical and cost outcomes or biomarkers of kidney injury for patients with preoperative kidney impairment (estimated glomerular filtration rate [eGFR]<60 mL/minute) undergoing cardiac surgery.
  
  
  METHODS
  A single-center randomized controlled trial recruited, patients between 2010 and 2013, with a 12-months follow-up.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  One hundred ninety-nine patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
  
  
  METHODS
  Patients were assigned randomly to receive zero-balance ultrafiltration (Z-BUF) or not, with stratification for degree of kidney dysfunction and diabetes.
  
  
  RESULTS
  The authors assessed clinical efficacy and kidney function biomarkers. Cumulative probability of discharge from the intensive care unit (ICU) was assessed by Kaplan-Meier plots and was found not to be significantly different between the two trial arms (p = 0.61). After adjusting for EuroSCORE, diabetes, eGFR, cardioplegia types and type of surgery in a Cox proportional hazard model, hazard ratios (HR) for ICU length of stay between the Z-BUF and no-Z-BUF groups was not significantly different: HR (95% CI): 0.89 (0.66, 1.20; p = 0.44). In contrast, significant reductions in postoperative chest infections and the composite of clinical endpoints (death, strokes, and myocardial infarctions) in the Z-BUF group were observed. In addition, Z-BUF significantly abrogated the rise in the kidney damage markers urinary NGAL/creatinine ratio, urea, creatinine and eGFR during CPB and adverse events risks.
  
  
  CONCLUSIONS
  Z-BUF during bypass surgery is associated with significant reductions in morbidity and biomarkers of CPB-induced acute kidney injury soon after CPB, which are indicative of clearance of inflammatory/immune mediators from the circulation.
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust. Electronic address: matata_bashir@hotmail.com.
authors.forename: Bashir M
authors.initials: BM
authors.lastname: Matata
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust.
authors.forename: Nigel
authors.initials: N
authors.lastname: Scawn
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust.
authors.forename: Maureen
authors.initials: M
authors.lastname: Morgan
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust.
authors.forename: Sarah
authors.initials: S
authors.lastname: Shirley
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust.
authors.forename: Ian
authors.initials: I
authors.lastname: Kemp
authors.affiliation: School of Management.
authors.forename: Sarah
authors.initials: S
authors.lastname: Richards
authors.affiliation: Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Lane
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust.
authors.forename: Keith
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust.
authors.forename: Rodney
authors.initials: R
authors.lastname: Stables
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust.
authors.forename: Mark
authors.initials: M
authors.lastname: Jackson
authors.affiliation: School of Management.
authors.forename: Alan
authors.initials: A
authors.lastname: Haycox
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Mediratta
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D016037:Single-Blind Method; D014462:Ultrafiltration / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology
keywords: cardiac surgery; cardiopulmonary bypass surgery; impaired kidney function; randomized clinical trial; zero-balanced ultrafiltration