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Title: A double-blind randomised feasibility trial of angiotensin-2 in cardiac surgery
Authors: Coulson TG 
Miles LF 
Serpa Neto A
Pilcher D
Weinberg L
Landoni G
Zarbock A
Bellomo R
Keywords: angiotensin-2
cardiac surgery
kidney injury
randomised controlled trial
renal dysfunction
renal failure
Source: 2022 Sep;77(9):999-1009
Journal Title: Anaesthesia
Abstract: Acute kidney injury is common after cardiac surgery. Vasoplegic hypotension may contribute to kidney injury, and different vasopressors may have variable effects on kidney function. We conducted a double-blind, randomised feasibility trial comparing peri-operative angiotensin-2 with noradrenaline. We randomly allocated 60 patients at two centres to a blinded equipotent angiotensin-2 or noradrenaline infusion intra-operatively and for up to 48 h postoperatively, titrated to mean arterial pressure of 70-80 mmHg. Primary feasibility outcomes included consent rate, protocol adherence, infusion duration, mean arterial pressure maintenance in the target range and major adverse outcomes. Secondary outcomes included kidney injury rate. The consent rate was 47%. Protocol adherence was 100% in the angiotensin-2 group and 94% in the noradrenaline group. Study drug duration was median (IQR [range]) 217 (160-270 [30-315]) vs. 185 (135-301 [0-480]) min (p = 0.78) min intra-operatively, and 5 (0-16 [0-48]) vs. 14.5 (4.8-29 [0-48]) hours (p = 0.075) postoperatively for angiotensin-2 and noradrenaline, respectively. The mean arterial pressure target was achieved postoperatively in 25 of 28 (89%) of the angiotensin-2 group and 27 of 32 (84%) of the noradrenaline group. One participant had a stroke, one required extracorporeal support and three required renal replacement therapy, all in the noradrenaline group (p = 0.99, p = 0.99 and p = 0.1). Acute kidney injury occurred in 7 of 28 in the angiotensin-2 group vs. 12 of 32 patients in the noradrenaline group (p = 0.31). This pilot study suggests that a trial comparing angiotensin-2 with noradrenaline is feasible. Its findings justify further investigations of angiotensin-2 in cardiac surgery.
DOI: 10.1111/anae.15802
PubMed URL:
ISSN: 0003-2409
Grant Name: Angiotensin-two for Reduction of Acute Kidney Injury after cardiac surgery - a pilot to determine feasibility of a definitive double blind randomised controlled trial: A-TRAK. 
Type: Journal Article
Affiliates: Department of Anaesthesiology and Peri-Operative Medicine, Monash University and Alfred Health, Melbourne, Australia
Department of Anaesthesia, Austin Health, Melbourne, Australia
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
Department of Intensive Care, Alfred Health, Melbourne, Australia
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany
Department of Intensive Care, Austin Health, Melbourne, Australia
Study/Trial: Pilot/Feasibility Study
Appears in Collections:Scholarly and Clinical

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