The Effect Of Goal-Directed Fluid Therapy On The Development Of Acute Renal Failure In Patients With Cardiac Surgery

Abstract

Abstract Objective: AKI occurs in 5% to 42% of patients after cardiac surgery. The primary aim of this study was to investigate the effect of goal-directed fluid therapy in the perioperative period on the development of AKI in the early period in patients undergoing cardiac surgery.Methods: The study was designed prospectively at single academic center. Patients undergoing cardiac surgery were divided into two groups according to perioperative fluid management: Group Control (Group C, n=30): Fluid management was performed with traditional monitoring method. Group Study (Group S, n=30): It was performed with transesophageal doppler and transthoracic doppler fluid management. Clinical and hemodynamic data were recorded at preoperative (t0), postoperative 4th hour (t2), 24th hour (t3) and 48th hour (t4). Serum creatinine, GFR, Cystatin-C and KIM-1 values were measured as AKI indicators.Results: Postoperative fluid requirement was significantly lower in the study group (p=0.002). Postoperative total balance was significantly more negative in the study group than in the control group (p<0.0001). ERT requirement was significantly lower in the study group compared to the control group (intraoperative, p=0.02; postoperative, p=0.002). Cystatin-C was significantly lower in the study group at the postoperative 24th and 48th hours. (respectively, p<0.04, p<0.02). AKI development rates were similar between the groups (p>0.05).Conclusion: GDFT should be considered in the foreground because it shortens the length of hospital stay and reduces unnecessary fluid load in patients who are scheduled for major surgery. Cystatin-C can be used more prominently in the evaluation of AKI as a biomarker.