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

• Autor(a) principal: Silva, Wallace Andrino da
• Data de Publicação: 2020
• Outros Autores: Varela, Carlo Victor A., Pinheiro, Aline Macedo, Scherer, Paula Castro, Francisco, Rossana P.V., Torres, Marcelo Luis Abramides, Carmona, Maria José C., Bliacheriene, Fernando, Andrade, Lúcia C., Pelosi, Paolo, Malbouisson, Luiz Marcelo S.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Clinics
• Texto Completo: https://www.revistas.usp.br/clinics/article/view/173687
• topic: Preeclampsia; Acute Kidney Injury; Cesarean Section; Fluid Therapy

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 X1. Serum cystatin C and neutrophil gelatinaseassociated 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, po0.05). 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 (po0.05). In the restrictive fluid group, NGAL levels increased on postoperative day 1 compared to the preoperative period (po0.05) and decreased on postoperative day 2 compared to postoperative day 1 (po0.05). CONCLUSION: Among patients with severe preeclampsia, a restrictive fluid regimen during cesarean section was not associated with increased postoperative AKI.