cf7659ed76079d374ad67ac3de29bd15 jcm-12-07746.pdf d0045d01203c4b76486e9c67e14c4685a4870e6f jcm-12-07746.pdf 9e474225ec39cc4795c6d0533ac4c3422ee20a550fbe0d3e32a6084a5d39a38a jcm-12-07746.pdf Title: Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial Subject: Background: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether management with an individualized target reduces the incidence of CS-AKI. Methods: Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation. Adult patients submitted to valve replacement and/or bypass surgery with a high risk of CS-AKI evaluated by a Leicester score >30 were randomized to follow a target MPP of >75% of the calculated baseline or a standard hemodynamic management during the first postoperative 24 h. Results: Ninety-eight patients with an eGFR of 54 mL/min were included. There were no differences in MAP and MPP in the first 24 h between the randomized groups, although a higher use of noradrenaline was found in the intervention arm (38.78 vs. 63.27, p = 0.026). The percentage of time with MPP < 75% of measured baseline was similar in both groups (10 vs. 12.7%, p = 0.811). MAP during surgery was higher in the intervention group (73 vs. 77 mmHg, p = 0.008). The global incidence of CS-AKI was 36.7%, being 38.6% in the intervention group and 34.6% in the control group (p = 0.40). There were no differences in extrarenal complications between groups as well. Conclusion: An individualized hemodynamic management based on MPP compared to standard treatment in cardiac surgery patients was safe but did not reduce the incidence of CS-AKI in our study. Keywords: acute kidney injury; cardiac surgery; mean perfusion pressure; prevention; clinical trial Author: Alicia Molina-Andujar, José Rios, Gaston J. Piñeiro, Elena Sandoval, Cristina Ibañez, Eduard Quintana, Purificación Matute, Rut Andrea, Teresa Lopez-Sobrino, Jordi Mercadal, Enric Reverter, Irene Rovira, Ana Maria Villar, Sara Fernandez, Manel Castellà and Esteban Poch Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Dec 18 06:54:55 2023 CET ModDate: Mon Dec 18 07:03:33 2023 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 864952 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- YVVWOS+VnURWPalladioL Type 1 Custom yes yes no 10 0 JTFLMY+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 JFAXYD+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 KWBFAT+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 PURWBA+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 49 0 EILUJF+CMSY10 Type 1 Builtin yes yes no 71 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 78 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 88 0 ECJOJM+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 111 0 ECJMKA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 114 0 ECJMKC+PalatinoLinotype TrueType WinAnsi yes yes no 117 0 ECJMKE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 120 0 ECKDDB+PalatinoLinotype,Italic TrueType MacRoman yes yes no 155 0 ECJMKA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 158 0 ECJMKB+PalatinoLinotype CID TrueType Identity-H yes yes yes 161 0 ECJMKC+PalatinoLinotype TrueType WinAnsi yes yes no 167 0 ECJMKE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 170 0 ECJNHB+PalatinoLinotype TrueType MacRoman yes yes no 173 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-06-17 04:16:36 CEST RepresentationInformation: jcm-12-07746.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-06-16 19:16:31 CEST Size: 864952 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 277 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Children: Item: Title: Protocol Description Destination: subsection.2.1 Item: Title: Variables Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Cohort Baseline Characteristics Destination: subsection.3.1 Item: Title: Hemodynamic Variables and Fluid Balance during Intervention Period Destination: subsection.3.2 Item: Title: CS-AKI Description Destination: subsection.3.3 Item: Title: MPP Deficit as a Risk Factor for CS-AKI Destination: subsection.3.4 Item: Title: Patients Outcome Destination: subsection.3.5 Item: Title: Discussion Destination: section.4 Item: Title: References Destination: section.A. Info: Title: Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury The PrevHemAKI Randomized Controlled Trial Author: Alicia Molina-Andujar, José Rios, Gaston J. Piñeiro, Elena Sandoval, Cristina Ibañez, Eduard Quintana, Purificación Matute, Rut Andrea, Teresa Lopez-Sobrino, Jordi Mercadal, Enric Reverter, Irene Rovira, Ana Maria Villar, Sara Fernandez, Manel Castellà and Esteban Poch Subject: Background: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether management with an individualized target reduces the incidence of CS-AKI. Methods: Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation. Adult patients submitted to valve replacement and/or bypass surgery with a high risk of CS-AKI evaluated by a Leicester score >30 were randomized to follow a target MPP of >75% of the calculated baseline or a standard hemodynamic management during the first postoperative 24 h. Results: Ninety-eight patients with an eGFR of 54 mL/min were included. There were no differences in MAP and MPP in the first 24 h between the randomized groups, although a higher use of noradrenaline was found in the intervention arm (38.78 vs. 63.27, p = 0.026). The percentage of time with MPP < 75% of measured baseline was similar in both groups (10 vs. 12.7%, p = 0.811). MAP during surgery was higher in the intervention group (73 vs. 77 mmHg, p = 0.008). The global incidence of CS-AKI was 36.7%, being 38.6% in the intervention group and 34.6% in the control group (p = 0.40). There were no differences in extrarenal complications between groups as well. Conclusion: An individualized hemodynamic management based on MPP compared to standard treatment in cardiac surgery patients was safe but did not reduce the incidence of CS-AKI in our study. 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