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.

[1]  M. Pavesi,et al.  Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique , 1994, Perfusion.

[2]  P. Högger,et al.  Identification of the integral membrane protein RM3/1 on human monocytes as a glucocorticoid-inducible member of the scavenger receptor cysteine-rich family (CD163). , 1998, Journal of immunology.

[3]  S. Lemeshow,et al.  European system for cardiac operative risk evaluation (EuroSCORE). , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  T. Langmann,et al.  Regulation of scavenger receptor CD163 expression in human monocytes and macrophages by pro‐ and antiinflammatory stimuli , 2000, Journal of leukocyte biology.

[5]  J. Bonventre,et al.  Cell biology and molecular mechanisms of injury in ischemic acute renal failure. , 2000, Current opinion in nephrology and hypertension.

[6]  M. Moskowitz,et al.  Acute cardiovascular protective effects of corticosteroids are mediated by non-transcriptional activation of endothelial nitric oxide synthase , 2002, Nature Medicine.

[7]  B. Molitoris,et al.  Microvascular endothelial injury and dysfunction during ischemic acute renal failure. , 2002, Kidney international.

[8]  M. Paul-Clark,et al.  The FASEB Journal express article 10.1096/fj.02-0239fje. Published online December 3, 2002. Aberrant inflammation and resistance to glucocorticoids in Annexin 1 –/ – Mouse , 2022 .

[9]  W. Tsai,et al.  Effect of leukocyte depletion on endothelial cell activation and transendothelial migration of leukocytes during cardiopulmonary bypass. , 2004, The Annals of thoracic surgery.

[10]  R. Bellomo,et al.  Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group , 2004, Critical care.

[11]  Joseph V Bonventre,et al.  Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. , 2005, Journal of the American Society of Nephrology : JASN.

[12]  S. Arrigain,et al.  A clinical score to predict acute renal failure after cardiac surgery. , 2004, Journal of the American Society of Nephrology : JASN.

[13]  M. Okusa,et al.  Acute kidney injury associated with cardiac surgery. , 2005, Clinical journal of the American Society of Nephrology : CJASN.

[14]  P. Buehler,et al.  CD163 is the macrophage scavenger receptor for native and chemically modified hemoglobins in the absence of haptoglobin. , 2006, Blood.

[15]  H MacGregor,et al.  Effects of centrifugal and roller pumps on survival of autologous red cells in cardiopulmonary bypass surgery , 2006, Perfusion.

[16]  John T Granton,et al.  Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. , 2007, JAMA.

[17]  C. Schmid,et al.  A new equation to estimate glomerular filtration rate. , 2009, Annals of internal medicine.

[18]  S. Waikar,et al.  Creatinine kinetics and the definition of acute kidney injury. , 2009, Journal of the American Society of Nephrology : JASN.

[19]  M. Boodhwani,et al.  Effects of mild hypothermia and rewarming on renal function after coronary artery bypass grafting. , 2009, The Annals of thoracic surgery.

[20]  W. Buurman,et al.  Hemolysis is associated with acute kidney injury during major aortic surgery. , 2010, Kidney international.

[21]  R. Bellomo,et al.  Novel biomarkers, oxidative stress, and the role of labile iron toxicity in cardiopulmonary bypass-associated acute kidney injury. , 2010, Journal of the American College of Cardiology.

[22]  J. Stockman,et al.  A New Equation to Estimate Glomerular Filtration Rate , 2011 .

[23]  T. Athanasiou,et al.  Miniaturized extracorporeal circulation vs. off-pump coronary artery bypass grafting: What the evidence shows? , 2011, Perfusion.

[24]  Catherine D Krawczeski,et al.  Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery. , 2011, Journal of the American Society of Nephrology : JASN.

[25]  A. Renzulli,et al.  Acute kidney injury: a relevant complication after cardiac surgery. , 2011, Annals of Thoracic Surgery.

[26]  A. Garg,et al.  Preoperative Serum Brain Natriuretic Peptide and Risk of Acute Kidney Injury After Cardiac Surgery , 2012, Circulation.

[27]  J. Tijssen,et al.  Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. , 2012, JAMA.

[28]  E. Norwitz,et al.  Glucocorticoids enhance CD163 expression in placental Hofbauer cells. , 2013, Endocrinology.

[29]  P. Guida,et al.  Anti-inflammatory strategies to reduce acute kidney injury in cardiac surgery patients: a meta-analysis of randomized controlled trials. , 2014, Artificial organs.

[30]  T. J. Nickola,et al.  IL-1β induction of MUC5AC gene expression is mediated by CREB and NF-κB and repressed by dexamethasone. , 2014, American journal of physiology. Lung cellular and molecular physiology.