| Influence of Erythrocyte Transfusion on the Risk of Acute Kidney Injury after Cardiac Surgery Differs in Anemic and Nonanemic Patients. | |
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MedLine Citation:
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PMID: 21775877 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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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; W Scott Beattie |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-7-19 |
Journal Detail:
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Title: Anesthesiology Volume: - ISSN: 1528-1175 ISO Abbreviation: - Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-7-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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* Associate Professor, Department of Anesthesia, Toronto General Hospital, University Health Network, Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. † Assistant Professor, Department of Anesthesia, Toronto General Hospital, University Health Network, Department of Health Policy, Management, and Evaluation, University of Toronto, Keenan Research Centre, Li Ka Shing Knowledge Institute of Saint Michael's Hospital, Toronto, Ontario, Canada. ‡ Professor, Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University of Toronto. § Assistant Professor, Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto. ∥ Associate Professor, Division of Nephrology, Department of Medicine, University Health Network, University of Toronto. # Professor, Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto. ** Professor, Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto. |
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