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Off-pump CABG may reduce short-term kidney injury
New data indicate that off-pump CABG is associated with reduced risk for postoperative kidney injury compared with on-pump CABG. However, researchers report that the off-pump procedure was associated with no evidence of better preserved kidney function at 1 year.
Amit X. Garg, MD, PhD, from Western University, London, Ontario, and colleagues conducted a substudy of the CORONARY trial. The substudy included 2,932 patients from 63 sites in 16 countries randomly assigned in a 1:1 ratio to off-pump CABG (n=1,472) or on-pump CABG (n=1,460). The patients were enrolled in the kidney function substudy between January 2010 and November 2011 to record postoperative and 1-year serum creatinine concentrations.
The main outcomes included acute kidney injury within 30 days of surgery, defined as ≥50% increase in serum creatinine concentration from pre-randomization, and loss of kidney function at 1 year, defined as ≥20% loss in estimated glomerular filtration rate from pre-randomization, according to the study.
At 30 days, off-pump CABG reduced the risk for acute kidney injury compared with on-pump CABG (17.5% vs. 20.8%; RR=0.83; 95% CI, 0.72-0.97). However, the two groups did not differ in loss of kidney function at 1 year (17.1% off-pump vs. 15.3% on-pump; RR=1.1; 95% CI, 0.95-1.29), according to the results.
The substudy yielded similar findings with multiple alternate continuous and categorical definitions of acute kidney injury or kidney function loss, as well as in a subgroup of patients with baseline chronic kidney disease, according to the researchers.
“The use of off-pump vs on-pump CABG surgery reduced the risk of postoperative acute kidney injury; however, we failed to observe better kidney function with off-pump vs on-pump CABG surgery 1 year later,” Garg and colleagues wrote. “In this setting, an intervention that reduced the risk of mild to moderate acute kidney injury did not alter longer-term kidney function.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.