| Advance targeted transfusion in anemic cardiac surgical patients for kidney protection: an unblinded randomized pilot clinical trial. | |
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MedLine Citation:
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PMID: 22354243 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: : Acute kidney injury (AKI) is a serious complication of cardiac surgery, and preoperative anemia and perioperative erythrocyte transfusion are important risk factors. Prophylactic erythrocyte transfusion in anemic patients may, therefore, protect against AKI. METHODS: : In this unblinded, parallel-group, randomized pilot trial, 60 anemic patients (hemoglobin 10-12 g/dL) undergoing cardiac surgery with cardiopulmonary bypass were randomized (1:1) to prophylactic transfusion (2 units of erythrocytes transfused 1 to 2 days before surgery (n = 29) or standard of care (transfusions as indicated; n = 31). Between-group differences in severity of perioperative anemia, transfusion, and AKI (more than 25% drop in estimated glomerular filtration rate) were measured. The relationships between transfusion, iron levels, and AKI were also measured. RESULTS: : Perioperative anemia and erythrocyte transfusions were lower in the prophylactic transfusion group--median (25th, 75th percentiles) for nadir hemoglobin was 8.3 (7.9, 9.1) versus 7.6 (6.9, 8.2) g/dL (P = 0.0008) and for transfusion was 0 (0, 2) versus 2 (1, 4) units (P = 0.0002)--but between-group AKI rates were comparable (11 patients per group). In 35 patients with iron studies, perioperative transfusions were directly related to postoperative transferrin saturation (correlation coefficient 0.6; P = 0.0002), and high (more than 80%) transferrin saturation was associated with AKI (5/5 vs. 8/30; P = 0.005), implicating transfusion-related iron overload as a cause of AKI. CONCLUSIONS: : In anemic patients, prophylactic erythrocyte transfusion reduces perioperative anemia and erythrocyte transfusions, and may reduce plasma iron levels. Adequately powered studies assessing the effect of this intervention on AKI are warranted. |
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Authors:
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Keyvan Karkouti; Duminda N Wijeysundera; Terrence M Yau; Stuart A McCluskey; Christopher T Chan; Pui-Yuen Wong; Mark A Crowther; Siroos Hozhabri; W Scott Beattie |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 116 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-02-22 Completed Date: 2012-04-10 Revised Date: 2012-11-13 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 613-21 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesia and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. keyvan.karkouti@uhn.ca |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Kidney Injury
/
etiology*,
prevention & control* Aged Anemia / complications*, therapy* Cardiac Surgical Procedures / adverse effects* Erythrocyte Transfusion / methods* Female Humans Male Middle Aged Pilot Projects Time Factors |
| Grant Support | |
ID/Acronym/Agency:
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//Canadian Institutes of Health Research |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2012 Mar;116(3):513-4
[PMID:
22261797
]
Anesthesiology. 2012 Oct;117(4):919-20; author reply 921-2 [PMID: 22990193 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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