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Study: Restrictive approach to red blood cell transfusion in cardiac surgery can be as safe as liberal approach for AKI risk
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SAN DIEGO — A restrictive threshold approach to meeting red blood cell transfusion requirements can be as safe as a liberal approach for the risk of acute kidney injury in patients who undergo cardiac surgery, according to research presented at the ASN Kidney Week 2018.
“If we can safely reduce the number of red blood cell transfusions, it has many benefits. It could prevent transfusion-related adverse effects, it could conserve blood supply and reduce health care costs,“ Amit X. Garg, MD, PhD, of the London Health Sciences Centre in London, Ontario, said at a press briefing, here.
In the randomized controlled trial, which was a substudy of the Transfusion Requirements in Cardiac Surgery-III (TRICS-III) trial, Garg and colleagues enrolled 4,531 moderate-to-high-risk patients undergoing cardiac bypass surgery at 73 centers in 19 countries in a randomized trial from January 2014 and March 2017. Patients were assigned to two groups. For the 2,251 patients in the restrictive red blood cell transfusion threshold group, transfusion was when hemoglobin was less than 7.5 g/dL intraoperatively, and postoperatively until 28 days after surgery or until hospital discharge. The 2,280 patients in the liberal threshold group were transfused if hemoglobin level was less than 9.5 g/dL in the OR or ICU or less than 8.5 g/dL on the non-intensive care ward in the U.S. units.
Researchers defined AKI as an “increase in the postoperative serum creatinine concentration of [greater than or equal to] 0.3 mg/dL from the preoperative value within 48 hours of surgery, or [greater than or equal to] 50% within 7 days of surgery,” according to the abstract.
Overall, researchers found 27.7% of patients in the restrictive-threshold group had perioperative AKI compared with 27.9% of patients in the liberal-threshold group. Additionally, results were consistent with multiple alternative definitions of AKI as well as in a subgroup of patients who had preoperative CKD.
“It is safe from a kidney perspective to use less blood,” he said. – by Kristine Houck, MA, ELS
Reference:
Garg AX, et al. Paper FR-OR147. Presented at: ASN Kidney Week; Oct. 23-28, 2018; San Diego.
Disclosure: Garg reports government support funding (trial registration NCT02042898).