Project Details
Projekt
A Prospective Angiotensin II versus Noradrenaline trial for Hypotension management to reduce cardiac-surgery associated Acute Kidney Injury (PAN-AKI)
Applicant
Professor Dr. Alexander Zarbock
Subject Area
Anaesthesiology
Term
since 2024
Project identifier
Deutsche Forschungsgemeinschaft (DFG) - Project number 542931418
Vasoplegic syndrome is a form of distributive shock that is characterized by low arterial pressure with reduced systemic vascular resistance and normal or elevated cardiac output that occurs in 5 to 25% of patients undergoing cardiac surgery. Cardiac surgery patients with vasoplegic shock are at higher risk of organ failure, including acute kidney injury (AKI). Postsurgical AKI is associated with several adverse outcomes. Attempts to prevent AKI have largely been futile so far. Prior studies often started with the interventions after an AKI event, when a decline of kidney function (i.e. glomerular filtration rate) was already established. Application of norepinephrine is currently considered as the first-line therapy for vasoplegic shock, but all catecholamines have adverse effects, including myocardial ischemia and arrhythmias. In a recent observational trial, we demonstrated that there is a dysregulation in the renin-angiotensin-aldosterone system likely caused by a reduced angiotensin-converting enzyme activity after cardiac surgery. This dysregulation is associated with a cardiovascular instability and increased AKI rate after cardiac surgery. In a randomized controlled trial, we demonstrated that the use of Angiotensin II as a primary vasopressor in comparison to norepinephrine reduced the occurrence of moderate/severe AKI. The “A Prospective Angiotensin II versus Noradrenaline trial for Hypotension management to reduce cardiac-surgery associated Acute Kidney Injury (PAN-AKI)” multicenter, double-blinded RCT will address the clinically important question of whether in patients undergoing cardiac surgery, is treatment with angiotensin II as a primary vasopressor superior to norepinephrin in terms of the prevention of the occurrence of moderate/severe cardiac-surgery associated AKI. This evaluation will have a large and immediate impact on clinical practice and on patient outcomes in Germany and worldwide.
DFG Programme
Clinical Trials
