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Randomized Controlled Trial
. 2015 Dec;26(12):2947-51.
doi: 10.1681/ASN.2014080840. Epub 2015 May 7.

Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

Kirolos A Jacob  1 , David E Leaf  2 , Jan M Dieleman  3 , Diederik van Dijk  3 , Arno P Nierich  4 , Peter M Rosseel  5 , Joost M van der Maaten  6 , Jan Hofland  7 , Jan C Diephuis  8 , Fellery de Lange  9 , Christine Boer  10 , Jolanda Kluin  11 , Sushrut S Waikar  2 ; Dexamethasone for Cardiac Surgery (DECS) Study Group
Affiliations
Randomized Controlled Trial

Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

Kirolos A Jacob et al. J Am Soc Nephrol. 2015 Dec.

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 dexamethasone appeared to reduce the incidence of severe AKI after cardiac surgery in those with advanced CKD.

Trial registration: ClinicalTrials.gov NCT00293592.

Keywords: acute renal failure; cardiovascular; clinical trial; creatinine; dialysis; ischemia–reperfusion.

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References

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