Low Dose Continuous Furosemide Effect on Cardiac Surgery Patients With Kidney Dysfunction
Condition: Chronic Kidney Disease; Cardiac Disease
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic; Heart Diseases
Intervention: Furosemide in 0.9 % NaCl 100 Mg/100 mL (1 mg/mL); NaCl 0.9%
Intervention description: Furosemide 2 mg/hour infusion for 12 hours since induction; NaCl 0.9% 2 cc/hour for a period of 12 hours since anesthetic induction
Intervention MeSH terms: Furosemide
Phase: Phase 2
Study type: Interventional
Primary purpose: Prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Masking description: Allocation group was blinded for participants, care provider, and investigators
Enrollment: 90.0
Sex: All
Minimum age: 18 Years
Maximum age: 65 Years
Healthy volunteers: No
Keywords: Furosemide; Kidney Dysfunction; Glomerular Filtration Rate

Summary:

      Chronic kidney disease is an independent risk factor for cardiovascular disease associated
      with increased mortality rate during cardiac surgery in proportion to the kidney function.
      Chronic kidney disease is defined by decreased glomerular filtration rate (GFR) as classified
      by Kidney Disease: Improving Global Outcome (KDIGO). Deterioration of kidney function has a
      complex and multifactorial pathophysiologic derangement. In order to counter kidney injury
      associated with cardiac surgery, several pharmacologic and non-pharmacologic interventions
      have been studied to prevent perioperative deterioration of kidney function. Diuretics as
      pharmacologic measure are often used post-cardiac surgery to treat fluid overload and
      managing patient with acute kidney injury by preventing anuria. Loop diuretics (furosemide)
      may improve renal blood flow, decrease reabsorption in renal tubules, decrease oxygen demand
      and energy consumption (blocking potassium/sodium/2cloride co-transport in loop of Henle),
      and prevent hypoxic injury of renal medulla. Low dose continuous furosemide hypothetically
      has a protective effect on cardiac surgery patients with kidney dysfunction, measured
      improved glomerular filtration rate, decreased indication for therapeutic furosemide
      infusion, and decreased need of renal replacement therapy. On the other hand, administration
      of furosemide is rather harmful in severe kidney dysfunction. Therefore, the objective of
      this study is to determine the protective effect of low-dose continuous furosemide
      perioperative in cardiac surgery patients with mild to moderate kidney dysfunction.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Age 18 to 65 years old.

          -  Patient planned with elective cardiac surgery such as CABG, one cardiac valve
             replacement, one cardiac valve repair or two valves, CABG and replacement/repair one
             cardiac valve.

          -  Cardiac surgery performed using cardiopulmonary bypass machine.

          -  Patient with mild to moderate kidney dysfunction (GFR 30-89 mL/min/1.73m2) and never
             got renal replacement therapy before.

        Exclusion Criteria:

          -  Cardiac ejection fraction <40%.

          -  Patient with new preoperative acute renal failure by any cause.

          -  Sudden shift in cardiac surgery timing (emergency cardiac surgery or repeated
             procedure).

          -  Complex cardiac disease associated with intra aortic balloon pump use, replacement of
             more than two cardiac valves, coronary artery disease with severe valve disease, and
             patient with pulmonary hypertension, and cardiac surgery procedures for congenital
             heart disease.

          -  Patient with aortic abnormality, and/or has direct effect on renal artery.

          -  Patients concurrently enrolled in other study with other drugs being studied.

          -  Patient with hemodynamic disturbance caused by hemorrhage, sepsis, anaphylactic, or
             cardiogenic shock.

          -  Patient refuses to participate in the study.