Restrictive versus Liberal Fluid Therapy for Post-Cesarean Acute Kidney Injury in Severe Preeclampsia: a Pilot Randomized Clinical Trial

Wallace Andrino da Silva, Carlo Victor A Varela, Aline Macedo Pinheiro, Paula Castro Scherer, Rossana P V Francisco, Marcelo Luis Abramides Torres, Maria José C Carmona, Fernando Bliacheriene, Lúcia C Andrade, Paolo Pelosi, Luiz Marcelo S Malbouisson, Wallace Andrino da Silva, Carlo Victor A Varela, Aline Macedo Pinheiro, Paula Castro Scherer, Rossana P V Francisco, Marcelo Luis Abramides Torres, Maria José C Carmona, Fernando Bliacheriene, Lúcia C Andrade, Paolo Pelosi, Luiz Marcelo S Malbouisson

Abstract

Objectives: The aim of this study was to determine whether a restrictive compared to a liberal fluid therapy will increase postoperative acute kidney injury (AKI) in patients with severe preeclampsia.

Methods: A total of 46 patients (mean age, 32 years; standard deviation, 6.8 years) with severe preeclampsia were randomized to liberal (1500 ml of lactated Ringer's, n=23) or restrictive (250 ml of lactated Ringer's, n=23) intravenous fluid regimen during cesarean section. The primary outcome was the development of a postoperative renal dysfunction defined by AKI Network stage ≥1. Serum cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) were evaluated at postoperative days 1 and 2. ClinicalTrials.gov: NCT02214186.

Results: The rate of postoperative AKI was 43.5% in the liberal fluid group and 43.5% in the restrictive fluid group (p=1.0). Intraoperative urine output was higher in the liberal (116 ml/h, IQR 69-191) than in the restrictive fluid group (80 ml/h, IQR 37-110, p<0.05). In both groups, serum cystatin C did not change from postoperative day 1 compared to the preoperative period and significantly decreased on postoperative day 2 compared to postoperative day 1 (p<0.05). In the restrictive fluid group, NGAL levels increased on postoperative day 1 compared to the preoperative period (p<0.05) and decreased on postoperative day 2 compared to postoperative day 1 (p<0.05).

Conclusion: Among patients with severe preeclampsia, a restrictive fluid regimen during cesarean section was not associated with increased postoperative AKI.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1. Flow chart of the study…
Figure 1. Flow chart of the study design.

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Source: PubMed

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