Abstract
BackgroundCardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication following coronary bypass graft (CABG) surgery. Multi-factorial causes of CSA-AKI involve oxidative stress and inflammation. Erythropoietin (EPO) has been shown from many studies to have a reno-protective effect. The present study was conducted to examine the role of EPO in preventing CSA-AKI.MethodsThis prospective, randomized, double-blind, placebo-controlled trial was conducted in the Cardiovascular and Thoracic Unit. One hundred patients randomly received either 200 U/kg of rHuEPO (n = 50) or saline (n = 50) intravenously three days before operation, and rHuEPO 100 U/kg or saline at operation time. The serum creatinine (SCr), estimated glomerular filtration rate (eGFR) and urine neutrophil gelatinase-associated lipocaline (NGAL) were measured in order to evaluate renal injury following CABG.ResultsThe incidence of CSA-AKI was significantly lower in rHuEPO group (14%) when compared with the placebo group (38%; p < 0.01). The mean intensive care unit (ICU) and hospital stays of the rHuEPO group were significantly shorter than the placebo group (p < 0.01). Postoperative increases in SCr and decreases in eGFR were significantly lower in the rHuEPO group than the placebo group (p < 0.05). The mean urine NGAL in rHuEPO group was significantly lower than the placebo group at 3 hr, 6 hr, 12 hr and 18 hr after CABG (p < 0.05), respectively.ConclusionsProphylaxis administration with intravenous rHuEPO before cardiac surgery decreased the incidence of CSA-AKI and urine NGAL with reduced days in ICU and hospital in elective CABG patients.Trial registrationClinicalTrials.gov: NCT01066351
Highlights
Cardiac surgery-associated acute kidney injury (CSA-Acute kidney injury (AKI)) is a common complication following coronary bypass graft (CABG) surgery
Study end points The primary endpoint of this study was the incidence of Cardiac surgery-associated acute kidney injury (CSA-AKI) in Recombinant human erythropoietin (rHuEPO) compared with placebo group
Secondary endpoints consisted of comparative changes in serum creatinine (SCr), estimated glomerular filtration rate (eGFR) and urine neutrophil gelatinase-associated lipocaline (NGAL) during the first three postoperative days, postoperative complications, length of stay in the intensive care unit (ICU) and hospital, a requirement for renal replacement therapy (RRT) and all causes hospital mortality between rHuEPO and placebo groups
Summary
Patient population Study patients were aged at least 18 years who were scheduled for elective CABG using the CPB technique at Thammasat Chalerm Prakiat Hospital during the period from January 2010 to March 2011 were included in the study. Patients with AKI before randomization, CKD stage 5 or unstable renal function (as evidenced by a change in SCr of ≥ 0.3 mg/dL, or ≥ 50%, within 14 days prior to the study), using the nephrotoxic drugs and/or contrast media administration within two weeks before operation and using rHuEPO prior to CABG were excluded. Demographic and baseline characteristics including patient age, sex, blood pressure, and co-morbidities were collected at time of group assignment. Study end points The primary endpoint of this study was the incidence of CSA-AKI in rHuEPO compared with placebo group. Secondary endpoints consisted of comparative changes in SCr, eGFR and urine NGAL during the first three postoperative days, postoperative complications, length of stay in the intensive care unit (ICU) and hospital, a requirement for renal replacement therapy (RRT) and all causes hospital mortality between rHuEPO and placebo groups. Statistical analyses were performed using SPSS (Version 15.0. for Windows; SPSS, Inc.) and significance was assigned when p values < 0.05
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