Acute Kidney Injury
Conditions
Keywords
Nitric Oxide, Sodium Nitrite, Cardiopulmonary bypass, cardioplegic cardiac arrest, coronary revacularization
Brief summary
The main objective of this study is to evaluate the efficacy of intravenous sodium nitrite compared with placebo in reducing the occurrence of CSA-AK as diagnosed by KDIGO criteria during the first 72 hrs after cardiac surgery in high-risk patients undergoing cardiac surgery. Secondary objectives are to determine whether IV sodium nitrite achieves adequate pharmacokinetics (PK) in patients undergoing cardiac surgery with the use of CPB.
Detailed description
Acute kidney injury is one of the most untoward consequences of cardiac-surgery with the use of CPB. As such it is associated with a high mortality and morbidity and health care expense. Unfortunately, currently, there is no effective preventive or treatment strategy for cardiac surgery-associated (CSA) AKI other than renal replacement therapy. It is postulated that a major mechanism of CSA-AKI is created by the ischemia reperfusion injury (IRI) resulting from aortic cross clamping and unclamping. This creates a cascade of events culminating in inflammation, microvascular dysfunction and tubular cell maladaptation and eventually renal tissue damage. Current treatment modalities that target the microcirculation such as blood pressure and cardiac output fails to prevent renal abnormalities and as such may be deleterious to the renal tissue microcirculation. The PI hypothesizes that a therapeutic strategy that limits IRI such as the administration of inhaled nitric oxide (NO) or sodium nitrite (NaNO2) would ameliorate CSA-AKI by limiting inflammatory injury to the kidney. The anion nitrite (NO2-) releases NO in biological systems and has been demonstrated to inhibit IR injury in the heart, liver and kidneys created by various pathologic states1-3 and improve outcomes in patients with acute myocardial infarction, in patients with pulmonary hypertension and is the putative active mediator of protection in liver-transplantation patients receiving inhaled nitric oxide4. The objective of this study is to determine whether the NO donor, nitrite will prevent I/R injury in patients at high risk of development of CSA-AKI undergoing open-heart surgery with cardiopulmonary bypass.
Interventions
DRUGSaline
A placebo (saline infusion) will be administered after induction of general anesthesia.
DRUGSodium Nitrite
Sodium nitrite infusion at a 267 mcg/kg/hr. will start after induction of general anesthesia via a dedicated IV line for 6 hrs.
Sponsors
University of Alabama at Birmingham
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
19 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients CCFS score ≥ 6 (Table 1) * Patients admitted to UAB cardiac intensive care unit (CICU) following elective cardiac surgery with cardiopulmonary bypass under general endotracheal anesthesia * 19 years old * Estimated glomerular filtration rate (eGFR) ≥ 30 ml/min/1.73 m2
Exclusion criteria
* Prisoners directly admitted from a correctional facility. * Children \< 19 years or under 50 kg body weight if age is unknown. * Patients enrolled in a concurrent ongoing interventional, randomized clinical trial. * Patients with end stage renal disease or preexisting GFR \<30 mL/min/1.73 m2 or need for dialysis. 34 * Patients with end stage heart disease on the cardiac transplant list. * Patients undergoing procedures without the use of CPB * All transplant patients. * Patients on ventricular assist devices. * Patients undergoing emergency procedures. * Patients with glucose 6-dehydrogenase deficiency * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Nitrite Metabolome Levels | baseline to 73 hrs post-operatively | Measuring nitrite, nitrate, and nitrosothiols levels |
| Biomarkers of Hemolysis | baseline to 73 hrs post-operatively | Measuring hemolysis indicators heme, Hb, hemopexin, and hemopectin |
| Biomarkers of Kidney Injury | baseline to 73 hrs post-operatively | Measuring kidney injury indicators creatine, neutrophil-associated gelatinase, lipocalin (NGAL) |
| Cell Cycle Stress | baseline to 73 hrs post-operatively | Measuring cell cycle arrest biomarkers TIMP-2, IGFBP-7 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Urine Output | baseline to 73 hrs post-operatively | Measuring total urine output |
| Biomarkers of Hepatic injury | baseline to 24 hours post-operatively | Measuring serum AST and ALT |
| Vasopressors Usage | baseline to 73 hrs post-operatively | Percentage of vasopressor usage between the control and intervention |
| Biomarkers of Kidney Injury | baseline to 24 hours post-operatively | Measuring kidney injury indicators creatine, neutrophil, lipocalin (NGAL) |
| Cell Cycle Stress | baseline to 24 hours post-operatively | Measuring cell cycle arrest biomarkers TIMP-2, IGFBP-7 |
| Biomarkers of Myocardial Injury | baseline to 24 hours post-operatively | Measuring myocardial injury indicators troponin and CKMB |
Countries
United States
Outcome results
None listed