Extracorporeal blood purification can cut cardiac surgery-associated AKI

For patients undergoing nonemergent cardiopulmonary bypass (CPB), use of an extracorporeal blood purification (EBP) device is associated with a lower rate of cardiac surgery-associated acute kidney injury (CSA-AKI), according to a study published online Oct. 9 in the Journal of the American Medical Association to coincide with the annual congress of the European Society of Intensive Care Medicine, held from Oct. 5 to 9 in Barcelona, Spain.

Xosé Pérez-Fernández, Ph.D., from L’Hospitalet de Llobregat in Barcelona, Spain, and colleagues conducted a double-blind, randomized clinical trial in two tertiary hospitals to examine whether use of an EBP device reduces CSA-AKI after CPB. Adults undergoing nonemergent cardiac surgery who were at high risk for CSA-AKI were randomly assigned to receive EBP or standard care (169 and 174 patients, respectively).

The researchers found that the rate of CSA-AKI was 28.4 and 39.7 percent in the EBP and standard-care groups, respectively. In most of the predefined clinical secondary end points or post hoc exploratory end points, there were no significant differences observed. In terms of CSA-AKI reduction, EBP was more effective for patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction (<40 percent), and lower body mass index (<30 kg/m²) in a sensitivity analysis. The groups did not differ in adverse events.

“The use of a nonselective EBP device connected to the CPB circuit in a nonemergent population of patients undergoing cardiac surgery was associated with a significant reduction of CSA-AKI in the first seven days after the surgical procedure,” the authors write.

One author disclosed ties to Exthera and SphingoTec.

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