Extracorporeal blood purification during cardiac surgery may help reduce post-surgical AKI
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Key takeaways:
- The cardiac surgery-linked AKI rate was 28.4% among patients on extracorporeal blood purification.
- The rate was 39.7% for standard care.
A nonselective extracorporeal blood purifier connected to the cardiopulmonary bypass circuit during nonemergent cardiac surgery may help reduce post-surgical AKI, data show.
“There are multiple mechanisms that lead to AKI after cardiac surgery. Common causes include hemodynamic instability due to hypovolemia or vasoplegia and/or exposure to nephrotoxic medications,” Xosé Pérez-Fernández, PhD, of the Facultat de Medicina Campus de Bellvitge Universitat de Barcelona L’Hospitalet de Llobregat in Barcelona, Spain, wrote with colleagues. “However, there are still knowledge gaps about the effects and mechanisms of cardiac surgery in [cardiac surgery-associated] CSA-AKI occurrence besides the complexity of interindividual risk factors that may predispose for this complication.”
Researchers evaluated adults undergoing nonemergent cardiac surgery to assess whether an extracorporeal blood purification reduces the risk for CSA-AKI.
The study assessed 343 patients undergoing nonemergent cardiac surgery and who were at high risk for AKI across two tertiary hospitals in Spain.
Patients enrolled in the double-blind SIRAKI02 clinical trial from 2016 to 2021 were randomly selected to receive extracorporeal blood purification or standard care.
Overall, 169 patients had extracorporeal blood purification and 174 had usual care.
The main outcome was CSA-AKI in the 7 days after randomization.
Follow-up data were collected through 2022.
The rate of CSA-AKI was 28.4% in the extracorporeal blood purification group (95% CI, 21.7%-35.8%) and 39.7% for standard care (95% CI, 32.3%-47.3%). The adjusted difference of was 10.4% (95% CI, 2.3%-18.5%).
Researchers found no differences in most secondary or exploratory end points.
Extracorporeal blood purification was more effective in reducing CSA-AKI for patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction and lower BMI, according to the researchers. No differences were observed in adverse events tracking.
“The use of a nonselective [extracorporeal blood purifier] device connected to the [cardiopulmonary bypass] circuit in a nonemergent population of patients undergoing cardiac surgery was associated with a significant reduction of CSA-AKI in the first 7 days after surgery,” Pérez-Fernández and colleagues wrote.
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