title: Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery.
abstract: Administration of prophylactic glucocorticoids has been suggested as a strategy to reduce postoperative AKI and other adverse events after cardiac surgery requiring cardiopulmonary bypass. In this post hoc analysis of a large placebo-controlled randomized trial of dexamethasone in 4465 adult patients undergoing cardiac surgery, we examined severe AKI, defined as use of RRT, as a primary outcome. Secondary outcomes were doubling of serum creatinine level or AKI-RRT, as well as AKI-RRT or in-hospital mortality (RRT/death). The primary outcome occurred in ten patients (0.4%) in the dexamethasone group and in 23 patients (1.0%) in the placebo group (relative risk, 0.44; 95% confidence interval, 0.19 to 0.96). In stratified analyses, the strongest signal for potential benefit of dexamethasone was in patients with an eGFR<15 ml/min per 1.73 m(2). In conclusion, compared with placebo, intraoperative dexamethasone appeared to reduce the incidence of severe AKI after cardiac surgery in those with advanced CKD.
authors.affiliation: Departments of Anesthesiology and Intensive Care Medicine and Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; k.a.jacob@umcutrecht.nl.
authors.forename: Kirolos A
authors.initials: KA
authors.lastname: Jacob
authors.affiliation: Division of Renal Medicine, the Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts;
authors.forename: David E
authors.initials: DE
authors.lastname: Leaf
authors.affiliation: Departments of Anesthesiology and Intensive Care Medicine and.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Dieleman
authors.affiliation: Departments of Anesthesiology and Intensive Care Medicine and.
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
authors.affiliation: Department of Anesthesiology, Isala Klinieken, Zwolle, The Netherlands;
authors.forename: Arno P
authors.initials: AP
authors.lastname: Nierich
authors.affiliation: Department of Anesthesiology Amphia Ziekenhuis, Breda, The Netherlands;
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rosseel
authors.affiliation: Department of Anesthesiology University Medical Center, Groningen, The Netherlands;
authors.forename: Joost M
authors.initials: JM
authors.lastname: van der Maaten
authors.affiliation: Department of Anesthesiology Erasmus Medical Center, Rotterdam, The Netherlands;
authors.forename: Jan
authors.initials: J
authors.lastname: Hofland
authors.affiliation: Department of Anesthesiology Medisch Spectrum Twente, Enschede, The Netherlands;
authors.forename: Jan C
authors.initials: JC
authors.lastname: Diephuis
authors.affiliation: Department of Cardiac Anesthesiology Medical Center Leeuwarden, Leeuwarden, The Netherlands; and.
authors.forename: Fellery
authors.initials: F
authors.lastname: de Lange
authors.affiliation: Department of Anesthesiology Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Christine
authors.initials: C
authors.lastname: Boer
authors.affiliation: Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands;
authors.forename: Jolanda
authors.initials: J
authors.lastname: Kluin
authors.affiliation: Division of Renal Medicine, the Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts;
authors.forename: Sushrut S
authors.initials: SS
authors.lastname: Waikar
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012720:Severity of Illness Index
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
keywords: acute renal failure; cardiovascular; clinical trial; creatinine; dialysis; ischemia–reperfusion