Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial

• Published in: Clinics (São Paulo, Brazil) Vol. 73; p. e327
• Main Authors: Amendola, Cristina Prata, Silva-Jr, João Manoel, Carvalho, Taisa, Sanches, Luciana Coelho, de Andrade e Silva, Ulysses Vasconcelos, Almeida, Rosana, Burdmann, Emmanuel, Lima, Emerson, Barbosa, Fabiana Ferreira, Ferreira, Renata Souza, Carmona, Maria José C, Malbouisson, Luiz Marcelo Sá, Nogueira, Fernando A M, Auler-Júnior, José Otavio Costa, Lobo, Suzana Margareth
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-01-2018; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Faculdade de Medicina / USP; Elsevier España
• Subjects: Acute Kidney Injury; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Aged; Case-Control Studies; Creatinine; Early Goal-Directed Therapy; Female; Hemodynamics; Hospital Mortality; Humans; Male; MEDICINE, GENERAL & INTERNAL; Middle Aged; Original; Oxygen Consumption; Patient Care Planning; Perfusion; Prospective Studies; Treatment Outcome; Creatinine; Acute Kidney Injury; Hemodynamics; Perfusion; Oxygen Consumption
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.6061/clinics/2018/e327

Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goal-directed therapy conducted during the early stages of acute kidney injury could change the course of the disease.
This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906.
A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p=0.001) compared to the control group (p=0.572). No significant differences in the change in serum creatinine level (p=0.96), persistence of acute kidney injury beyond 72h (p=0.064) or the need for renal replacement therapy (p=0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5).
Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.