title: Influence of erythrocyte transfusion on the risk of acute kidney injury after cardiac surgery differs in anemic and nonanemic patients.
abstract: 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.
authors.affiliation: Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. keyvan.karkouti@uhn.on.ca
authors.forename: Keyvan
authors.initials: K
authors.lastname: Karkouti
authors.forename: Duminda N
authors.initials: DN
authors.lastname: Wijeysundera
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Yau
authors.forename: Stuart A
authors.initials: SA
authors.lastname: McCluskey
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.forename: Pui-Yuen
authors.initials: PY
authors.lastname: Wong
authors.forename: W Scott
authors.initials: WS
authors.lastname: Beattie
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000503:physiopathology; D000368:Aged; D000740:Anemia / Q000150:complications*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors