Restrictive versus Liberal Fluid Therapy for Post-Cesarean Acute Kidney Injury in Severe Preeclampsia: a Pilot Randomized Clinical Trial

Imagem de Miniatura
Arquivos
art_SILVA_Restrictive_versus_Liberal_Fluid_Therapy_for_PostCesarean_Acute_2020.PDF.pdf (660.23 KB)
Citações na Scopus
1
Tipo de produção
article
Data de publicação
2020
DOI
SciELO
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
HOSPITAL CLINICAS, UNIV SAO PAULO
Autores
VARELA, Carlo Victor A.
PINHEIRO, Aline Macedo
PELOSI, Paolo
Citação
CLINICS, v.75, article ID e1797, 8p, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
OBJECTIVES: The aim of this study was to determine whether a restrictive compared to a liberal fluid therapy will increase postoperative acute kidney injury (AKI) in patients with severe preeclampsia. METHODS: A total of 46 patients (mean age, 32 years; standard deviation, 6.8 years) with severe preeclampsia were randomized to liberal (1500 ml of lactated Ringer's, n=23) or restrictive (250 ml of lactated Ringer's, n=23) intravenous fluid regimen during cesarean section. The primary outcome was the development of a postoperative renal dysfunction defined by AKI Network stage >= 1. Serum cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) were evaluated at postoperative days 1 and 2. ClinicalTrials.gov: NCT02214186. RESULTS: The rate of postoperative AKI was 43.5% in the liberal fluid group and 43.5% in the restrictive fluid group (p=1.0). Intraoperative urine output was higher in the liberal (116 ml/h, IQR 69-191) than in the restrictive fluid group (80 ml/h, IQR 37-110, p < 0.05). In both groups, serum cystatin C did not change from postoperative day 1 compared to the preoperative period and significantly decreased on postoperative day 2 compared to postoperative day 1 (p<0.05). In the restrictive fluid group, NGAL levels increased on postoperative day 1 compared to the preoperative period (p <0.05) and decreased on postoperative day 2 compared to postoperative day 1 (p < 0.05). CONCLUSION: Among patients with severe preeclampsia, a restrictive fluid regimen during cesarean section was not associated with increased postoperative AKI.
Palavras-chave
Preeclampsia, Acute Kidney Injury, Cesarean Section, Fluid Therapy
URI
https://observatorio.fm.usp.br/handle/OPI/37811
Referências
  1. Al-Ghamdi AA, 2018, SAUDI J ANAESTH, V12, P311, DOI 10.4103/sja.SJA_689_17
  2. BJORNSSON TD, 1979, CLIN PHARMACOKINET, V4, P200, DOI 10.2165/00003088-197904030-00003
  3. BOSCH JP, 1995, SEMIN NEPHROL, V15, P381
  4. Callaghan WM, 2012, OBSTET GYNECOL, V120, P1029, DOI [http://10.1097/AOG.0b013e31826d60c5, 10.1097/AOG.0b013e31826d60c5]
  5. Campbell N, 2003, BRIT J ANAESTH, V90, P241, DOI 10.1093/bja/aeg036
  6. Dennis AT, 2012, ANAESTHESIA, V67, P646, DOI 10.1111/j.1365-2044.2012.07055.x
  7. Eswarappa M, 2016, RENAL FAILURE, V38, P889, DOI 10.3109/0886022X.2016.1164015
  8. Goldstein SL, 2014, J INTENSIVE CARE MED, V29, P183, DOI 10.1177/0885066612465816
  9. Guo HX, 2012, REPROD SCI, V19, P712, DOI 10.1177/1933719111431001
  10. Huang CH, 2017, BMC NEPHROL, V18, DOI 10.1186/s12882-017-0551-4
  11. Hutcheon JA, 2011, BEST PRACT RES CL OB, V25, P391, DOI 10.1016/j.bpobgyn.2011.01.006
  12. Inker LA, 2012, NEW ENGL J MED, V367, P20, DOI 10.1056/NEJMoa1114248
  13. Kee WDN, 2001, ANESTH ANALG, V93, P703, DOI 10.1097/00000539-200109000-00033
  14. Kim SM, 2013, REPROD SCI, V20, P1083, DOI 10.1177/1933719113477480
  15. Kirkpatrick AW, 2013, INTENS CARE MED, V39, P1190, DOI 10.1007/s00134-013-2906-z
  16. Laterza OF, 2002, CLIN CHEM, V48, P699
  17. Levey AS, 2007, CLIN CHEM, V53, P766, DOI 10.1373/clinchem.2006.077180
  18. Martin GS, 2005, CRIT CARE MED, V33, P1681, DOI 10.1097/01.CCM.0000171539.47006.02
  19. Martin GS, 2002, CRIT CARE MED, V30, P2175, DOI 10.1097/00003246-200210000-00001
  20. Mehrabadi A, 2014, BMJ-BRIT MED J, V349, DOI 10.1136/bmj.g4731
  21. Mehta RL, 2007, CRIT CARE, V11, DOI 10.1186/cc5713
  22. Mercier FJ, 2012, CURR OPIN ANESTHESIO, V25, P286, DOI 10.1097/ACO.0b013e3283530dab
  23. Mishra J, 2004, AM J NEPHROL, V24, P307, DOI 10.1159/000078452
  24. Myles PS, 2018, NEW ENGL J MED, V378, P2263, DOI 10.1056/NEJMoa1801601
  25. Pan PH, 2004, REGION ANESTH PAIN M, V29, P610, DOI 10.1016/j.rapm.2004.09.006
  26. Patel ML, 2013, INT J NEPHROL RENOV, V6, P181, DOI 10.2147/IJNRD.S45523
  27. Rajendram R, 2014, CRIT CARE, V18, DOI 10.1186/cc13709
  28. Roberts JM, 2013, OBSTET GYNECOL, V122, P1122, DOI 10.1097/01.AOG.0000437382.03963.88
  29. ROUT CC, 1993, ANESTHESIOLOGY, V79, P262, DOI 10.1097/00000542-199308000-00011
  30. Rule AD, 2006, KIDNEY INT, V69, P399, DOI 10.1038/sj.ki.5000073
  31. Tenstad O, 1996, SCAND J CLIN LAB INV, V56, P409, DOI 10.3109/00365519609088795
  32. Thornton CE, 2011, HYPERTENS PREGNANCY, V30, P169, DOI 10.3109/10641950902972140
  33. Tuffnell DJ, 2005, BJOG-INT J OBSTET GY, V112, P1625, DOI 10.1111/j.1471-0528.2005.00770.x
  34. von Dadelszen P, 2010, OBSTET GYNECOL, V116, P659, DOI 10.1097/AOG.0b013e3181eb669d
  35. Wiedemann HP, 2006, NEW ENGL J MED, V354, P2564
  36. Xiao J, 2013, HYPERTENS PREGNANCY, V32, P439, DOI 10.3109/10641955.2013.827203
  37. Zieleskiewicz L, 2014, ANESTHESIOLOGY, V120, P906, DOI 10.1097/ALN.0000000000000102

Coleções
Artigos e Materiais de Revistas Científicas - FM/MOG
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/ICr
Artigos e Materiais de Revistas Científicas - HC/InCor
Carregar mais