Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery.
Administration of prophylactic glucocorticoids has been suggested as a strategy to reduce postoperative AKI and other adverse events after cardiac surgery requiring cardiopulmonary bypass. In this post hoc analysis of a large placebo-controlled randomized trial of dexamethasone in 4465 adult patients undergoing cardiac surgery, we examined severe AKI, defined as use of RRT, as a primary outcome. Secondary outcomes were doubling of serum creatinine level or AKI-RRT, as well as AKI-RRT or in-hospital mortality (RRT/death). The primary outcome occurred in ten patients (0.4%) in the dexamethasone group and in 23 patients (1.0%) in the placebo group (relative risk, 0.44; 95% confidence interval, 0.19 to 0.96). In stratified analyses, the strongest signal for potential benefit of dexamethasone was in patients with an eGFR<15 ml/min per 1.73 m(2). In conclusion, compared with placebo, intraoperative dexamethasone appeared to reduce the incidence of severe AKI after cardiac surgery in those with advanced CKD.
['Jacob|Kirolos A|KA|', 'Leaf|David E|DE|', 'Dieleman|Jan M|JM|', 'van Dijk|Diederik|D|', 'Nierich|Arno P|AP|', 'Rosseel|Peter M|PM|', 'van der Maaten|Joost M|JM|', 'Hofland|Jan|J|', 'Diephuis|Jan C|JC|', 'de Lange|Fellery|F|', 'Boer|Christine|C|', 'Kluin|Jolanda|J|', 'Waikar|Sushrut S|SS|', '|||']
D058186:Acute Kidney Injury D000368:Aged D000893:Anti-Inflammatory Agents D006348:Cardiac Surgical Procedures D002315:Cardiopulmonary Bypass D003907:Dexamethasone D005260:Female D005919:Glomerular Filtration Rate D017052:Hospital Mortality D006801:Humans D007430:Intraoperative Care D008297:Male D008875:Middle Aged D017582:Renal Replacement Therapy D012720:Severity of Illness Index
creatinine acute renal failure cardiovascular clinical trial dialysis ischemia–reperfusion