Perioperative Nitric Oxide Conditioning Reduces Acute Kidney Injury in Cardiac Surgery Patients with Chronic Kidney Disease (the DEFENDER Trial): A Randomized Controlled Trial.
Summary
In 136 CKD patients undergoing cardiopulmonary bypass surgery, perioperative inhaled NO (80 ppm intraoperatively and for 6 hours post-op) reduced AKI incidence (RR 0.59) and postoperative pneumonia (RR 0.5), and improved 6-month eGFR versus control, with acceptable safety parameters.
Key Findings
- Perioperative inhaled NO reduced AKI within 7 days (23.5% vs 39.7%; RR 0.59; P=0.043).
- Improved 6-month eGFR in the NO group (50 vs 45 ml·min−1·1.73 m−2; P=0.038).
- Halved postoperative pneumonia incidence (14.7% vs 29.4%; RR 0.5; P=0.039) with acceptable safety profiles.
Clinical Implications
Perioperative inhaled NO may be considered to mitigate AKI risk and postoperative pneumonia in CKD patients undergoing CPB, pending replication and cost-effectiveness analyses.
Why It Matters
This pragmatic RCT identifies an immediately actionable perioperative intervention that reduces both renal and respiratory complications in high-risk cardiac surgery patients.
Limitations
- Single trial with modest sample size; external validity across diverse centers and surgeries remains to be established.
- Primary endpoint focused on renal outcomes; mechanisms for pneumonia reduction warrant further study.
Future Directions
Multicenter trials, mechanistic studies on NO-mediated organ protection, and cost-effectiveness analyses to inform perioperative guidelines.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- II - Well-designed randomized controlled trial in a specific high-risk surgical population.
- Study Design
- OTHER