Studying the Effect of Goal-Directed Blood Flow Management on Kidney Injury After Kidney Removal Surgery

What this Trial Is About

Researchers are investigating the effects of goal-directed hemodynamic management on kidney injury in patients undergoing radical nephrectomy or nephroureterectomy, surgeries performed for renal cell carcinoma and upper tract urothelial carcinoma. These surgeries often lead to acute kidney injury AKI, which increases the risk of chronic kidney disease CKD. This study aims to determine if managing blood flow and pressure during surgery can reduce AKI occurrence and improve long-term kidney health. The study compares two approaches during surgery one group receives goal-directed hemodynamic management involving active hydration, inotropes dobutamine, and forced diuresis to maintain specific targets for pulse pressure variation, mean arterial pressure, and urine output. The other group receives routine care with standard fluid infusion and blood pressure targets. Post-surgery, blood pressure is carefully managed for 48 hours in the goal-directed group, while routine care continues for the other group. Participants will be monitored for up to 7 days after surgery to assess the incidence of acute kidney injury, and for up to 2 years to evaluate new or worsening chronic kidney disease. Additional outcomes include heart injury, delirium, surgical site infections, and survival without major events. The study involves regular monitoring of vital signs, kidney function, and other health assessments during hospitalization and follow-up visits to evaluate the long-term effects of the different management approaches.

Goal-directed Hemodynamic Management and Kidney Injury After Radical Nephrectomy or Nephroureterectomy