Coronary Artery Disease
Conditions
Brief summary
Cardiac surgery associated acute kidney injury (CSA-AKI) has been recognized as the second most common cause of hospital acquired AKI. The development of CSA-AKI is independently associated with an increased risk of in-hospital death. There are currently no biomarkers that could identify patients at higher risk for AKI and current risk predictor scores that are based on clinical and demographic information are inadequate. Therefore, a diagnostic test for predicting AKI risk in this clinical context would assist clinicians to optimize surgical strategy and postoperative care to prevent CSA-AKI occurrence and improve patient outcomes. The primary purpose of this study is to validate a panel of biomarkers identified in the discovery study (referred to as AKI-Sapere prognostic) to identify patients at risk for all stages of CSA-AKI.
Interventions
None listed
Sponsors
WakeMed Health and Hospitals
Johns Hopkins University
Hoag Memorial Hospital Presbyterian
Sapere Bio
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients (\>40 years) undergoing non-emergency (urgent or scheduled) cardiac surgery using cardiopulmonary bypass (CABG or combined CABG/valve). * Patients must be able to understand English and be willing to sign informed consent.
Exclusion criteria
* Emergency surgery * Off-pump coronary bypass grafting * Aortic aneurysm repair * Congenital heart disease repair * Heart transplant or left ventricular assist device patient * Severe heart failure (left ventricular ejection fraction \<25%) * Hemodynamic instability or requiring preoperative vasopressors or IABP * Pre-existing kidney disease (eGFR \<30 mL/min/1.73 m2) or renal transplantation. * Presence of major active infection (chronic or acute, eg, sepsis, HIV, pneumonia) * Chronic liver disease/cirrhosis * Participation in an additional trial at the time of surgery or anytime within 30d of surgery where intervention could potentially alter renal health (unless in the control arm)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Development of stage 1 or higher postoperative AKI as defined by the KDIGO classification (stage 1 = sCr value of ≥0.3 mg/dL in the first 48h or a relative increase of ≥50% in peak sCr from baseline within 7 days post-surgery) | within 7 days post-surgery |
Secondary
| Measure | Time frame |
|---|---|
| Development of 30-day persistent kidney impairment (eGFR change of ≥25% from baseline at the 30-day follow-up visit) | 30 days post-surgery |
| Development of new onset atrial fibrilation | within 7 days post-surgery |
| Development of moderate to severe AKI (sCr increase of ≥100% within 7 days post surgery or a sCr increase of ≥100% from baseline within 7 days and urine output <0.5 mL/kg/h for >12h) | within 7 days post-surgery |
| Development of 30-day major adverse cardiac events (MACE30): a composite of myocardial infarction (MI), stroke, heart failure, and death | 30 days post-surgery |
| Development of the combination of MAKE30 and MACE30 (major adverse reno-cardiovascular events [MARCE30]) | 30 days post-surgery |
| Development of 30-day major adverse kidney events (MAKE30): a composite of persistently impaired renal function (sCr increase of ≥0.5 mg/dL from baseline [pre-surgery]), new dialysis, and death | 30 days post-surgery |
Countries
United States
Outcome results
None listed