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Effect of Methylprednisolone on Acute Kidney Injury in Patients Undergoing Cardiac Surgery With a Cardiopulmonary Bypass Pump: A Randomized Controlled Trial Publisher Pubmed



Garg AX1 ; Chan MTV2 ; Cuerden MS1 ; Devereaux PJ3 ; Abbasi SH4 ; Hildebrand A5 ; Lamontagne F6 ; Lamy A7 ; Noiseux N8 ; Parikh CR9 ; Perkovic V10 ; Quantz M11 ; Rochon A12 ; Royse A13 Show All Authors
Authors
  1. Garg AX1
  2. Chan MTV2
  3. Cuerden MS1
  4. Devereaux PJ3
  5. Abbasi SH4
  6. Hildebrand A5
  7. Lamontagne F6
  8. Lamy A7
  9. Noiseux N8
  10. Parikh CR9
  11. Perkovic V10
  12. Quantz M11
  13. Rochon A12
  14. Royse A13
  15. Sessler DI14
  16. Shah PJ15
  17. Sontrop JM1, 16
  18. Tagarakis GI16
  19. Teoh KH17
  20. Vincent J18
  21. Walsh M3
  22. Yared JP19
  23. Yusuf S20
  24. Whitlock RP18
Show Affiliations
Authors Affiliations
  1. 1. Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
  2. 2. Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, Hong Kong
  3. 3. Departments of Health Research Methods, Evidence, and Impact, Medicine, McMaster University, Hamilton, ON, Canada
  4. 4. Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
  6. 6. Departement de medecine, Faculte de medecine et des Sciences de la Sante, Universite de Sherbrooke, Sherbrooke, QC, Canada
  7. 7. Department of Surgery, McMaster University, Hamilton, ON, Canada
  8. 8. Department of Cardiac Surgery, Universite de Montreal, Montreal, QC, Canada
  9. 9. Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, United States
  10. 10. George Institute for Global Health, Sydney, Australia
  11. 11. Division of Cardiac Surgery, London Health Sciences Centre, University Hospital, London, ON, Canada
  12. 12. Montreal Heart Institute, Universite de Montreal, Montreal, QC, Canada
  13. 13. Department of Surgery, University of Melbourne, Melbourne, Australia
  14. 14. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
  15. 15. Department of Cardiac Surgery, Princess Alexandra Hospital, Brisbane, Australia
  16. 16. Department of Cardiovascular and Thoracic Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
  17. 17. Division of Cardiac Surgery, Southlake Regional Health Centre, Newmarket, ON, Canada
  18. 18. Population Health Research Institute, Hamilton, ON, Canada
  19. 19. Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
  20. 20. Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada

Source: CMAJ Published:2019


Abstract

BACKGROUND: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. METHODS: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007–2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater (≥ 26.5 µmol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery. RESULTS: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease. INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery. © 2019 Joule Inc.
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1. Methylprednisolone in Patients Undergoing Cardiopulmonary Bypass (Sirs): A Randomised, Double-Blind, Placebo-Controlled Trial, The Lancet (2015)