The Journal of the American Medical Association (JAMA) publishes in its latest issue a study led by researchers from IDIBELL and Bellvitge University Hospital that shows that the use of a new extracorporeal blood purification membrane significantly reduces acute kidney failure after highly complex heart surgery. The SIRAKI02 study has been led by the IDIBELL and Bellvitge Hospital research group on innate immunity and pathology of the critical patient and has involved cardiac surgeons, anesthesiologists, biochemists and perfusionists from the same hospital. In addition, specialists from the Germans Trias i Pujol and the Santa Creu i Sant Pau hospitals have also made a fundamental contribution.
Simultaneous to its publication in JAMA, the study has been presented by its first author, Dr. Xosé Luis Pérez Fernández, at the European Society of Intensive Care Medicine Congress (ESICM), which was held from 7 to 9 October in Barcelona. In March 2023, the preliminary results were already presented at the 42nd International Symposium on Intensive Care & Emergency Medicine, held in Brussels.
Acute kidney failure is a sudden loss of the kidneys’ ability to remove harmful debris carried by blood. It is an important secondary problem among admitted patients in critical condition, and also a frequent consequence of cardiac surgery, especially of highly complex ones. With this study, researchers wanted to analyse whether such cases of renal failure after a complex cardiac operation decrease in the event that, during surgery, an enlarged adsorption membrane is connected to the cardiopulmonary bypass. This type of state-of-the-art membrane began being used a few years ago for continuous renal replacement therapies in ICUs and for the management of sepsis, but this has been the first time, after different studies, that its use has been associated with clinical benefits.
The trial included 343 patients from Bellvitge and Germans Trias i Pujol hospitals who underwent surgeries between 2016 and 2022 that required cardiopulmonary bypass for more than 90 minutes (mainly double heart valve replacement surgeries, or heart valve replacement and coronary artery bypass). From the Biochemistry Laboratory of the Hospital de Sant Pau, the patients’ inflammatory response was evaluated by inflammatory measures quantification during and after surgery. The results show that, in the control group (169 people), 40% of cases suffered acute kidney failure during the week after the intervention, while in the group of patients that used the new membrane (174 people), this number was reduced to 28%. In addition, scientists could verify that the device does not cause additional problems for patients and that perfusion nurses – experts in cardiopulmonary bypass devices – were able to manipulate it easily.
If these results are confirmed, the routine use of these devices could be established in patients at risk who undergo cardiac surgery with cardiopulmonary bypass. It is also likely that this device will have other clinical benefits for the patient and shorten their stay in the ICU, although a study with a higher number of patients will be needed to confirm this.
The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research center created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.
IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).