Spare the Blood, but Save the Kidneys

Passik, Cary S.; Fernandes, Eugene; D'Amico, Anne; Maldarelli, William; Parikh, Chirag R.

doi:10.1016/j.athoracsur.2010.11.051

Cited by 2 publications

(1 citation statement)

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“…Tolerance of permissive anemia is important since perioperative blood conservation strategies are evolving and shown to be effective and associated with better outcomes. 29,30 However, it is also well known that excessively low hematocrit can be associated with postoperative AKI. 31,32 Thus, our observations suggest that judicious transfusion of PRBC up to 2 units may be safe and prevent postoperative AKI.…”

Section: Discussionmentioning

confidence: 99%

Blood transfusions are associated with urinary biomarkers of kidney injury in cardiac surgery

Khan

Coca

Hong

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objective Cardiac surgery is a major cause of acute kidney injury. In this setting receipt of blood transfusions appears to associate with a higher risk of AKI, as measured using serum creatinine values. We examined this association further, using urinary biomarkers of kidney injury. Methods 1210 adults underwent cardiac surgery and were divided into three groups based on the receipt of intraoperative packed red blood cell units (PRBC): no blood (n=894), ≤ 2 PRBC (n=206) and > 2 PRBC (n=110). AKI was defined as: i) Doubling of serum creatinine from the pre-operative value; ii) first post-operative urinary interleukin-18 in the 5th quintile; iii) first postoperative urinary neutrophil gelatinase-associated lipocalin in the 5th quintile. We determined the relative risk for AKI outcome according to PRBC group after adjusting for 12 pre-operative and surgical variables. Using the Sobel test for mediation analysis, we also evaluated the role of biomarkers in causing AKI through alternative pathways. Results AKI was more common in those who received >2 PRBC. In patients receiving > 2 PRBC, the adjusted RRs were 2.3 (95% CI 1.2-4.4, p 0.01), 1.36 (95% CI 1.0-1.9, p 0.05), and 1.34 (95% CI 1.0-1.8, p 0.06) for doubling of serum creatinine, urinary IL-18 in the 5th quintile (>60 pg/ml), and urinary NGAL in the 5th quintile (>102 ng/ml), respectively. Furthermore, the effect of PRBC transfusion on AKI was partially mediated by IL-18. Conclusions Receipt of two or more PRBC during cardiac surgery is associated with a greater risk of AKI defined by serum creatinine and kidney injury biomarkers.

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