scholarly journals Advance Targeted Transfusion in Anemic Cardiac Surgical Patients for Kidney Protection

2012 ◽  
Vol 116 (3) ◽  
pp. 613-621 ◽  
Author(s):  
Keyvan Karkouti ◽  
Duminda N. Wijeysundera ◽  
Terrence M. Yau ◽  
Stuart A. McCluskey ◽  
Christopher T. Chan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pilot Trial ◽  
Transferrin Saturation ◽  
Kidney Injury ◽  
Standard Of Care ◽  
Group Differences ◽  
Erythrocyte Transfusion ◽  
Preoperative Anemia ◽  
Parallel Group ◽  
Perioperative Anemia

Introduction : Acute kidney injury (AKI) is a serious complication of cardiac surgery, and preoperative anemia and perioperative erythrocyte transfusion are important risk factors. Prophylactic erythrocyte transfusion in anemic patients may, therefore, protect against AKI. Methods : In this unblinded, parallel-group, randomized pilot trial, 60 anemic patients (hemoglobin 10-12 g/dL) undergoing cardiac surgery with cardiopulmonary bypass were randomized (1:1) to prophylactic transfusion (2 units of erythrocytes transfused 1 to 2 days before surgery (n = 29) or standard of care (transfusions as indicated; n = 31). Between-group differences in severity of perioperative anemia, transfusion, and AKI (more than 25% drop in estimated glomerular filtration rate) were measured. The relationships between transfusion, iron levels, and AKI were also measured. Results : Perioperative anemia and erythrocyte transfusions were lower in the prophylactic transfusion group--median (25th, 75th percentiles) for nadir hemoglobin was 8.3 (7.9, 9.1) versus 7.6 (6.9, 8.2) g/dL (P = 0.0008) and for transfusion was 0 (0, 2) versus 2 (1, 4) units (P = 0.0002)--but between-group AKI rates were comparable (11 patients per group). In 35 patients with iron studies, perioperative transfusions were directly related to postoperative transferrin saturation (correlation coefficient 0.6; P = 0.0002), and high (more than 80%) transferrin saturation was associated with AKI (5/5 vs. 8/30; P = 0.005), implicating transfusion-related iron overload as a cause of AKI. Conclusions : In anemic patients, prophylactic erythrocyte transfusion reduces perioperative anemia and erythrocyte transfusions, and may reduce plasma iron levels. Adequately powered studies assessing the effect of this intervention on AKI are warranted.

scholarly journals Influence of Erythrocyte Transfusion on the Risk of Acute Kidney Injury after Cardiac Surgery Differs in Anemic and Nonanemic Patients

2011 ◽  
Vol 115 (3) ◽  
pp. 523-530 ◽  
Author(s):  
Keyvan Karkouti ◽  
Duminda N. Wijeysundera ◽  
Terrence M. Yau ◽  
Stuart A. McCluskey ◽  
Christopher T. Chan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Propensity Score ◽  
Conditional Logistic Regression ◽  
Kidney Injury ◽  
Erythrocyte Transfusion ◽  
Preoperative Anemia ◽  
Chi Square ◽  
Propensity Score Methods ◽  
Chi Square Test

Background Acute kidney injury (AKI) after cardiac surgery is a major health issue. Two important risk factors for AKI are preoperative anemia and perioperative erythrocyte transfusion, and elucidating their relationship may help in devising preventive strategies. Methods In this cohort study of 12,388 adults who underwent cardiac surgery with cardiopulmonary bypass and received three units or less of erythrocytes on the day of surgery, the authors used propensity score methods and conditional logistic regression to explore the relationship between preoperative anemia (hemoglobin less than 12.5 g/dL), erythrocyte transfusion on the day of surgery, and AKI (more than 50% decrease in estimated glomerular filtration rate from preoperative to postoperative day 3-4). Results AKI occurred in 4.1% of anemic patients (n = 94/2,287) and 1.6% of nonanemic patients (n = 162 of 10,101) (P < 0.0001). In the 2,113 propensity-score matched pairs, anemic patients had higher AKI rates than nonanemic patients (3.8% vs. 2.0%; P = 0.0007). AKI rates increased in direct proportion to the amount of erythrocytes transfused, and this increase was more pronounced in anemic patients: in anemic patients, the rate increased from 1.8% among those not transfused to 6.6% among those transfused three units (chi-square test for trend P < 0.0001), whereas in nonanemic patients, it increased from 1.7% among those not transfused to 3.2% among those transfused three units (chi-square test for trend P = 0.1). Conclusions Anemic patients presenting for cardiac surgery are more susceptible to transfusion-related AKI than nonanemic patients. Interventions that reduce perioperative transfusions may protect anemic patients against AKI.

Influence of Erythrocyte Transfusion on the Risk of Acute Kidney Injury After Cardiac Surgery Differs in Anemic and Nonanemic Patients

2012 ◽  
Vol 56 (4) ◽  
pp. 164-165
Author(s):  
Keyvan Karkouti ◽  
Duminda N. Wijeysundera ◽  
Terrence M. Yau ◽  
Stuart A. Mc Cluskey ◽  
Christopher T. Chan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Erythrocyte Transfusion

Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology

2021 ◽  
pp. 108925322110136
Author(s):  
Nathan Clendenen ◽  
Bryan Ahlgren ◽  
Mark J. Robitaille ◽  
Elijah Christensen ◽  
Joseph Morabito ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Mechanical Circulatory Support ◽  
Kidney Injury ◽  
Circulatory Support ◽  
Preoperative Anemia ◽  
Future Directions ◽  
Transcatheter Aortic Valve

The year 2020 was marred by the emergence of a deadly pandemic that disrupted every aspect of life. Despite the disruption, notable research accomplishments in the practice of cardiothoracic anesthesiology occurred in 2020 with an emphasis on optimizing care, improving outcomes, and expanding what is possible for patients undergoing cardiac surgery. This year’s edition of Noteworthy Literature Review will focus on specific themes in cardiac anesthesiology that include preoperative anemia, predictors of acute kidney injury following cardiac surgery, pain management modalities, anticoagulation strategies after transcatheter aortic valve replacement, mechanical circulatory support, and future directions in research.

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