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

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art_AMENDOLA_Goaldirected_therapy_in_patients_with_early_acute_kidney_2018.PDF (1.08 MB)
Citações na Scopus
8
Tipo de produção
article
Data de publicação
2018
Editora
HOSPITAL CLINICAS, UNIV SAO PAULO
DOI
Indexadores
SciELO
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Autores
AMENDOLA, Cristina Prata
CARVALHO, Taisa
SANCHES, Luciana Coelho
SILVA, Ulysses Vasconcelos de Andrade e
ALMEIDA, Rosana
LIMA, Emerson
BARBOSA, Fabiana Ferreira
FERREIRA, Renata Souza
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
CLINICS, v.73, article ID UNSP e327, 7p, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
OBJECTIVES: 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 goaldirected therapy conducted during the early stages of acute kidney injury could change the course of the disease. METHODS: 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. RESULTS: 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.O.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). CONCLUSIONS: Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.
Palavras-chave
Oxygen Consumption, Hemodynamics, Acute Kidney Injury, Creatinine, Perfusion
URI
https://observatorio.fm.usp.br/handle/OPI/29835
Referências
  1. Allgren RL, 1997, NEW ENGL J MED, V336, P828, DOI 10.1056/NEJM199703203361203
  2. Brienza N, 2009, CRIT CARE MED, V37, P2079, DOI 10.1097/CCM.0b013e3181a00a43
  3. Cantarovich F, 2004, AM J KIDNEY DIS, V44, P402, DOI 10.1053/j.ajkd.2004.05.021
  4. Silva VTCE, 2009, KIDNEY INT, V75, P982, DOI 10.1038/ki.2009.3
  5. Endre ZH, 2010, KIDNEY INT, V77, P1020, DOI 10.1038/ki.2010.25
  6. Friedrich JO, 2005, ANN INTERN MED, V142, P510, DOI 10.7326/0003-4819-142-7-200504050-00010
  7. Fuller BM, 2012, CURR OPIN CRIT CARE, V18, P267, DOI 10.1097/MCC.0b013e3283532b8a
  8. Hirschberg R, 1999, KIDNEY INT, V55, P2423, DOI 10.1046/j.1523-1755.1999.00463.x
  9. Hoste EAJ, 2008, CRIT CARE MED, V36, pS146, DOI 10.1097/CCM.0b013e318168c590
  10. Hoste EAJ, 2006, CRIT CARE, V10, DOI 10.1186/cc4915
  11. Jansen TC, 2010, AM J RESP CRIT CARE, V182, P752, DOI 10.1164/rccm.200912-1918OC
  12. Kellum JA, 2015, J AM SOC NEPHROL, V26, P2231, DOI 10.1681/ASN.2014070724
  13. Kellum JA, 2013, CRIT CARE, V17, DOI 10.1186/cc11454
  14. KNAUS WA, 1985, CRIT CARE MED, V13, P818, DOI 10.1097/00003246-198510000-00009
  15. Lassnigg A, 2000, J AM SOC NEPHROL, V11, P97
  16. Levy MM, 2003, CRIT CARE MED, V31, P1250, DOI 10.1097/01.CCM.0000050454.01978.3B
  17. Lin SM, 2006, SHOCK, V26, P551, DOI 10.1097/01.shk.0000232271.09440.8f
  18. Lobo SM, 2013, CURR OPIN CRIT CARE, V19, P346, DOI 10.1097/MCC.0b013e3283632ef1
  19. Nguyen HB, 2004, CRIT CARE MED, V32, P1637, DOI 10.1097/01.CCM.0000132904.35713.A7
  20. Pinsky MR, 2016, INTENS CARE MED, V42, P258, DOI 10.1007/s00134-015-3746-9
  21. Rhodes A, 2010, INTENS CARE MED, V36, P1327, DOI 10.1007/s00134-010-1869-6
  22. Rivers E, 2001, NEW ENGL J MED, V345, P1368, DOI 10.1056/NEJMoa010307
  23. Santos WJQ, 2006, CRIT CARE, V10, DOI 10.1186/cc4904
  24. Stone GW, 2003, JAMA-J AM MED ASSOC, V290, P2284, DOI 10.1001/jama.290.17.2284
  25. Thomson R, 2014, J CRIT CARE, V29, P997, DOI 10.1016/j.jcrc.2014.06.011
  26. Vincent JL, 1996, INTENS CARE MED, V22, P707, DOI 10.1007/s001340050156
  27. Wacharasint P, 2012, SHOCK, V38, P4, DOI 10.1097/SHK.0b013e318254d41a

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/08
Artigos e Materiais de Revistas Científicas - LIM/12
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