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.

中文翻译：

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血管紧张素 2 在心脏手术中的双盲随机可行性试验*

急性肾损伤在心脏手术后很常见。血管麻痹性低血压可能导致肾损伤，并且不同的血管升压药可能对肾功能产生不同的影响。我们进行了一项双盲、随机可行性试验，比较了围手术期血管紧张素 2 和去甲肾上腺素。我们将两个中心的 60 名患者随机分配到术中和术后长达 48 小时的盲法等效血管紧张素 2 或去甲肾上腺素输注，滴定至平均动脉压 70-80 mmHg。主要可行性结果包括同意率、方案依从性、输注持续时间、目标范围内的平均动脉压维持和主要不良结果。次要结局包括肾损伤率。同意率为47%。血管紧张素-2 组的方案依从率为 100%，去甲肾上腺素组为 94%。研究药物持续时间中位数（IQR [范围]）217（160-270 [30-315]）vs. 185（135-301 [0-480]）分钟（p = 0.78），术中和 5（0 –16 [0–48]) 与 14.5 (4.8–29 [0–48]) 小时 (p = 0.075) 分别用于血管紧张素 2 和去甲肾上腺素。血管紧张素 2 组 28 人中的 25 人（89%）和去甲肾上腺素组 32 人中的 27 人（84%）术后达到平均动脉压目标。一名参与者中风，一名需要体外支持，三名需要肾脏替代治疗，均在去甲肾上腺素组（p = 0.99、p = 0.99 和 p = 0.1）。血管紧张素-2 组 28 例患者中有 7 例发生急性肾损伤，去甲肾上腺素组 32 例患者中有 12 例发生急性肾损伤（p = 0.31）。这项初步研究表明，比较血管紧张素 2 与去甲肾上腺素的试验是可行的。