Preoperative Short-Term Calorie Restriction for Prevention of Acute Kidney Injury After Cardiac Surgery: A Randomized, Controlled, Open-Label, Pilot Trial.

Autor: Grundmann F; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany., Müller RU; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany.; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Germany., Reppenhorst A; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany., Hülswitt L; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany., Späth MR; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany., Kubacki T; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany., Scherner M; Department of Cardiothoracic Surgery, University of Cologne, Germany., Faust M; Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany., Becker I; Institute of Medical Statistics and Computational Biology, University of Cologne, Germany., Wahlers T; Department of Cardiothoracic Surgery, University of Cologne, Germany., Schermer B; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany.; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Germany., Benzing T; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany.; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Germany., Burst V; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Germany volker.burst@uk-koeln.de.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2018 Mar 13; Vol. 7 (6). Date of Electronic Publication: 2018 Mar 13.
DOI: 10.1161/JAHA.117.008181
Abstrakt: Background: Acute kidney injury is a frequent complication after cardiac surgery and is associated with adverse outcomes. Although short-term calorie restriction (CR) has proven protective in rodent models of acute kidney injury, similar effects have not yet been demonstrated in humans.
Methods and Results: CR_KCH (Effect of a Preoperative Calorie Restriction on Renal Function After Cardiac Surgery) is a randomized controlled trial in patients scheduled for cardiac surgery. Patients were randomly assigned to receive either a formula diet containing 60% of the daily energy requirement (CR group) or ad libitum food (control group) for 7 days before surgery. In total, 82 patients were enrolled between April 16, 2012, and February 5, 2015. There was no between-group difference in the primary end point of median serum creatinine increment after 24 hours (control group: 0.0 mg/dL [-0.1 - (+0.2) mg/dL]; CR group: 0.0 mg/dL [-0.2 - (+0.2) mg/dL]; P =0.39). CR prevented a rise in median creatinine at 48 hours (control group: +0.1 mg/dL [0.0 - 0.3 mg/dL]; CR group: -0.1 mg/dL [-0.2 - (+0.1) mg/dL]; P =0.03), with most pronounced effects observed in male patients and patients with a body mass index >25. This benefit persisted until discharge: Median creatinine decreased by 0.1 mg/dL (-0.2 - 0.0 mg/dL) in the CR group, whereas it increased by 0.1 mg/dL (0.0 - 0.3 mg/dL; P =0.0006) in the control group. Incidence of acute kidney injury was reduced by 5.8% (41.7% in the CR group compared with 47.5% in the control group). Safety-related events did not differ between groups.
Conclusions: Despite disappointing results with respect to creatinine rise within the first 24 hours, the benefits observed at later time points and the subgroup analyses suggest the protective potential of short-term CR in patients at risk for acute kidney injury, warranting further investigation.
Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01534364.
(© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
Databáze: MEDLINE
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