Safety of a Restrictive versus Liberal Approach to Red Blood Cell Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial.

Autor:	Garg AX; Division of Nephrology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada; amit.garg@lhsc.on.ca., Badner N; Department of Anesthesia & Clinical Pharmacology, University of British Columbia, Kelowna, British Columbia, Canada., Bagshaw SM; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada., Cuerden MS; Division of Nephrology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada., Fergusson DA; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Gregory AJ; Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada., Hall J; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Hare GMT; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Khanykin B; Cardiothoracic Anesthesiology Department, Copenhagen University Hospital, Copenhagen, Denmark., McGuinness S; Cardiothoracic and Vascular Intensive Care and High Dependency Unit, Auckland City Hospital, Auckland, New Zealand., Parikh CR; Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland., Roshanov PS; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada., Shehata N; Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; and., Sontrop JM; Division of Nephrology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada., Syed S; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada., Tagarakis GI; Department of Cardiothoracic Surgery, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece., Thorpe KE; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Verma S; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Wald R; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Whitlock RP; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada., Mazer CD; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2019 Jul; Vol. 30 (7), pp. 1294-1304. Date of Electronic Publication: 2019 Jun 20.
DOI:	10.1681/ASN.2019010004
Abstrakt:	Background: Safely reducing red blood cell transfusions can prevent transfusion-related adverse effects, conserve the blood supply, and reduce health care costs. Both anemia and red blood cell transfusion are independently associated with AKI, but observational data are insufficient to determine whether a restrictive approach to transfusion can be used without increasing AKI risk. Methods: In a prespecified kidney substudy of a randomized noninferiority trial, we compared a restrictive threshold for red blood cell transfusion (transfuse if hemoglobin<7.5 g/dl, intraoperatively and postoperatively) with a liberal threshold (transfuse if hemoglobin<9.5 g/dl in the operating room or intensive care unit, or if hemoglobin<8.5 g/dl on the nonintensive care ward). We studied 4531 patients undergoing cardiac surgery with cardiopulmonary bypass who had a moderate-to-high risk of perioperative death. The substudy's primary outcome was AKI, defined as a postoperative increase in serum creatinine of ≥0.3 mg/dl within 48 hours of surgery, or ≥50% within 7 days of surgery. Results: Patients in the restrictive-threshold group received significantly fewer transfusions than patients in the liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer transfusions in the restricted-threshold group compared with the liberal-threshold group; P <0.001). AKI occurred in 27.7% of patients in the restrictive-threshold group (624 of 2251) and in 27.9% of patients in the liberal-threshold group (636 of 2280). Similarly, among patients with preoperative CKD, AKI occurred in 33.6% of patients in the restrictive-threshold group (258 of 767) and in 32.5% of patients in the liberal-threshold group (252 of 775). Conclusions: Among patients undergoing cardiac surgery, a restrictive transfusion approach resulted in fewer red blood cell transfusions without increasing the risk of AKI. (Copyright © 2019 by the American Society of Nephrology.)
Databáze:	MEDLINE
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