Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

Kirolos A. Jacob, David E. Leaf, Jan M. Dieleman, Diederik van Dijk, Arno P. Nierich, Peter M. Rosseel, Joost M. van der Maaten, Jan Hofland, Jan C. Diephuis, Fellery de Lange, Christine Boer, Jolanda Kluin, Sushrut S. Waikar

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Abstract

Administration of prophylactic glucocorticoids has been suggested as a strategy to reduce postoperative AKI and other adverse events after cardiac surgery requiring cardiopulmonary bypass. In this post hoc analysis of a large placebo-controlled randomized trial of dexamethasone in 4465 adult patients undergoing cardiac surgery, we examined severe AKI, defined as use of RRT, as a primary outcome. Secondary outcomes were doubling of serum creatinine level or AKI-RRT, as well as AKI-RRT or in-hospital mortality (RRT/death). The primary outcome occurred in ten patients (0.4%) in the dexamethasone group and in 23 patients (1.0%) in the placebo group (relative risk, 0.44; 95% confidence interval, 0.19 to 0.96). In stratified analyses, the strongest signal for potential benefit of dexamethasone was in patients with an eGFR <15 ml/min per 1.73 m(2). In conclusion, compared with placebo, intraoperative dexannethasone appeared to reduce the incidence of severe AKI after cardiac surgery in those with advanced CKD
Original languageEnglish
Pages (from-to)2947-2951
JournalJournal of the American Society of Nephrology
Volume26
Issue number12
DOIs
Publication statusPublished - 2015

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