Non-pharmacologic nephroprotective strategies combined with nitric oxide delivery in cardiac surgical patients with chronic kidney disease

Introduction: One of the promising areas of nephroprotection in cardiac surgery is perioperative nitric oxide donation. The combined using of Goal-Directed Perfusion (GDP), Kidney Disease Improving Global Outcomes (KDIGO) and nitric oxide delivery strategies can reduce the incidence of acute kidney injury by targeting different links in the pathogenesis of kidney injury. Objective: To assess the nephroprotective properties of nitric oxide delivery in combination with KDIGO and GDP strategies during cardiac surgery with cardiopulmonary bypass in patients with chronic kidney disease.Methods: The study included 136 cardiac surgery patients with chronic kidney disease. The patients were randomized into 2 groups of 68 individuals each. The complex of non-pharmacological nephroprotection methods KDIGO and GDP was used in the control group. In the main group, perioperative delivery of nitric oxide was performed along with a set of KDIGO and GDP measures.Results: In the main group, the incidence of acute kidney injury was significantly lower compared to the control: 23.5% versus 39.7% (p = 0.043), respectively. Both groups did not differ in the concentration of renal injury biomarkers. In the control group, the concentration of exhaled nitric oxide significantly decreased 2 hours after surgery (p < 0.001), while in the main group no changes were recorded (p = 0.966). Conclusion: During cardiac surgery in patients with chronic kidney disease, delivery of nitric oxide in combination with the KDIGO and GDP measures reduced the incidence of acute kidney injury compared with the isolated using of non-pharmacological nephroprotective methods via leveling the perioperative deficiency of endogenous nitric oxide but did not affect the expression of kidney injury biomarkers. ClinicalTrials.gov ID NCT05757557 Received 31 October 2024. Revised 21 November 2024. Accepted 22 November 2024. FundingThe study was performed within the framework of the state assignment (topic No. 122123000017-3). Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: M.A. Tyo, N.O. Kamenshchikov, Yu.K. Podoksenov, B.N. KozlovData collection and analysis: M.A. Tyo, I.V. Kravchenko, E.A. Churilina, Yu.S. SvirkoStatistical analysis: M.A. Tyo, I.V. KravchenkoDrafting the article: M.A. TyoCritical revision of the article: N.O. Kamenshchikov, Yu.K. Podoksenov, B.N. KozlovFinal approval of the version to be published: M.A. Tyo, Yu.K. Podoksenov, I.V. Kravchenko, E.A. Churilina, Yu.S. Svirko, B.N. Kozlov, N.O. Kamenshchikov