October 16, 2021
Background: The incidence of acute kidney injury (AKI) remains high after partial nephrectomy. Ischemiareperfusion injury produced by renal hilum clamping during surgery might have contributed to the development of AKI. In this study we tested the hypothesis that goal-directed fluid and blood pressure management may reduce AKI in patients following partial nephrectomy.
Methods: This was a pilot randomized controlled trial. Adult patients who were scheduled to undergo partial
nephrectomy were randomized into two groups. In the intervention group, goal-directed hemodynamic
management was performed from renal hilum clamping until end of surgery; the target was to maintain stroke
volume variation < 6%, cardiac index 3.0–4.0 L/min/m2 and mean arterial pressure > 95 mmHg with crystalloid fluids and infusion of dobutamine and/or norepinephrine. In the control group, hemodynamic management was
performed according to routine practice. The primary outcome was the incidence of AKI within the first 3
postoperative days.
Results: From June 2016 to January 2017, 144 patients were enrolled and randomized (intervention group, n = 72;
control group, n = 72). AKI developed in 12.5% of patients in the intervention group and in 20.8% of patients in the control group; the relative reduction of AKI was 39.9% in the intervention group but the difference was not statistically significant (relative risk 0.60, 95% confidence interval [CI] 0.28–1.28; P = 0.180). No significant differences were found regarding AKI classification, change of estimated glomerular filtration rate over time, incidence of postoperative 30-day complications, postoperative length of hospital stay, as well as 30-day and 6-month mortality between the two groups.
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