Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery
Authors: Pérez-Fernández Xosé , Ulsamer Arnau , Cámara-Rosell María , Sbraga Fabrizio , Boza-Hernández Enric , Moret-Ruíz Enrique , Plata-Menchaca Erika , Santiago-Bautista Doménech , Boronat-García Patricia , Gumucio-Sanguino Víctor , Peñafiel-Muñoz Judith , Camacho-Pérez Mercedes , Betbesé-Roig Antoni , Forni Lui , Campos-Gómez Ana , Sabater-Riera Joan ,   SIRAKI02 Study Group, Ballus Noguera Josep , Huguet Briba Marta , Máñez Mendiluce Rafael , Esteve Urbano Francesc , Santafosta Gómez Eva , Alanez Saavedra Beymar Henry , Alonso Juste Virginia , Anguela Calvet Laura , Ávila Espinoza Renzo Steve , Cárdenas Campos Paola , Carrió Cardona Maria Luisa , Casanovas Lorenzo Teodor , Corral Ansa Luisa , Corral Vicente Francisco , Farrero Bayarri, Elisabet , Fuset Cabanes Mari Paz , Granada Vicente Rosa , López Delgado Juan Carlos , López Suñe Neus , Maisterra Santos Krystel , Moreno Gabriel Jesús , Oliver Juan Eva , Pons Serra Maria , Periche Pedra Elisabet , Sastre Pérez Paola , Soley Corderas Ricard , Rodríguez Castro, David , Torrado Santos Herminia Rosalía , Belda Ley Maria-Dolores , Di Paolo Fabio Alessandro , Lores Africa Carmen , Luna Solis Stephani-Maria , Ochagavía Calvo Ana Rosa , Serra Paya Pablo , Garcia Zaloña Alejandro , Via Clavero Gemma , Boza Hernández. Enric , Gil Dorado Albert , Bonet Burguera Antonia , Mendez Arias Esther , Garcia Ballester Sara , Leon Moreno Ariadna , Herrera Raul Senen , Sanz Iturbe Maite , Toscano Fernández Jacobo , Sbraga Fabrizio , Potocnik Potocnik Marcos , Osorio Higa Karina , Miralles Cassina Albert , Ortiz Berbel Daniel , Toral Sepúlveda David , Blasco Lucas Arnau , Dantas Ana , Cevallos Belen , Tejero Javier , Martinez Sepena Luis , Iglesias Gordillo Francis , Bautista Correa María José , Gutiérrez Yolanda , Modrego Montiel Elena , Albendea Perell Carlos , Castillo Jordi , Bruguera Elisenda , Oliveras Marga , Badia Gamarra Sara , Berastegui Garcia Elisabeth , Torres Aparicio Olga , Finestres Martin, Mónica , Buys Sara , Escudero Teixidó, Adrià , Massó Lago Eva , Ródenas Gómez Frederic , Rodríguez Núñez Mónica , Sariñena Fernandez, María Teresa , Ayala Gallardo Marc , Charlotte Philibert Viridiana Juliette , Sánchez Satorra Marius , Tomasa Irriguible Teresa , Valls Estrada Elisabet Angela , Hueso Miguel , Montero Nuria , Estruch Montserrat , Ordoñez Llanos Jordi , Hernandez Platero Lluisa , Rigo Bonnin Raul , Mora Virginia , Arnaiz Francos Aranzazu , Moreno durán Ana , Farigola Munuera Maria Elena , Julià Valls Cèlia , Gonzalez Pujol Albert , Romera Peregrina Iluminada , Lerma Brianso Cristina , Vera Martinez Anna , Prieto Palomino Susana , Carretero Aguilà Judit , Querol Parra  , Torà Navarro Lidia , Gonzalez Romero Mireia , Gonzalez Barrera Leila , Puente Mora Estefania , Briones Roc Marta , Pérez Sanchez Judit , Sanz Mellado Cristina , Garcia-Morron Gallego Ainoa , Campoy Andrea , Clavería Olga , Martinez Ocon Sandra , Vazquez Guillamet Blanca , Costa Capela Laura , Torreguitart Ingrid , Duran Colacios Maria , Puig Aragon Ariadna , Martinez Orellana Marta , Perez Soria Dolores , Peribañez Biedma Claudia , Gonzalez Del Hoyo Sara , Montoya Perez Ariadna , Sanchez Escudero Mireia , Mendoza Jimenez Cristina , Mesa Carrizosa Carolina , Ibern Navarro Laia , Lopez Gonzalez Oscar , Burgos Naranjo Maria Angeles , Moreno Duran Ana Mº , Rodriguez Contreras Pilar , Mora Muñiz Virginia , Cabezas Garrido Sonia , CarrionSanchez Agustin , Ausio Navarro Mar , Gascon Tomas Laia , Fuentes Mila Veronica , Chinchilla Perez Andrea , Castaño Camuñez Jessica , Nogales Ibañez Rita , Gimenez Vila Veronica , Sanjuan Navais Marta , Rodriguez Gonzalez Daniel , Gracia Martinez Andrea , Ojeda Jimenez Virginia , Hamed Loukili Soraya , Perea Sanchez Luis , Buendia Flores Raquel , Ramos Puig Josep Mº , Piquer Robles Clara , Marti Massanas Laura , Gil Ginebra Clara , Moreno Santoro Ana , Llamas Ruiz Judith , Hurtado Hidalgo Sandra , Pujadas Fernandez-Cordeiro Marta , Barranco Rodriguez Aida , Olivera Rodriguez Tania , Cardenete Villarroyo Aitor , Cruz Bardina Sandra , Serrano Jaureguizar Silvia , Del Rio Sanchez Anna , Llamas Bolta Marta , Gonzalez Lopez Carlos , Justel Garcia Rafael Francisco , Ruiz de Pablo Beatriz , Figuereo Beltre Danela , Fernandez Gallego Claudio , Julià Amill Ignasi , Delgado Ramis Luis , Romero Ferrer Bernat , Roig Pineda Regina , Cabaña Benjumea Ana , Anglada Oliván Mireia , Catalán Eraso Beatriz , Farré Estebe Ana , Ruiz Artola Victor , Bonet Cruces Esther , González Martínez Eva , Fabra Raduà Marc , Manciño Contreras Jose Maria , Martinez Vega Sergi , Raguer Pardo Laura , Perez González Victoria , Velázquez Torres Mercedes , Diago Ferré Mieria , Blasco Torres Cristina , Bielsa Berrocal Lara , Garces Gimeno Belen , Rodriguez Pedreira Paula , Muñoz del Rio Gloria , Bervel Franco David , Rodriguez Fanjul Javier , Benveniste Perez Eva , Chavez Diandreras Fernando , Bauça Socies Marta , Pons López Teresa , Mota Montané David Policarp , Coluccio Pereira Eduardo Enrique 
Published: October 2024

Importance

Cardiac surgery–associated acute kidney injury (CSA-AKI) remains a significant problem following cardiopulmonary bypass (CPB). Various strategies are proposed to attenuate CSA-AKI, including extracorporeal blood purification (EBP), but little is known about the effect of EBP through an acrylonitrile-sodium methallylsulfonate/polyethyleneimine membrane during CPB.

Objective

To determine whether the use of an EBP device in a nonemergent cardiac surgery population reduces CSA-AKI after CPB.

Design, Setting, and Participants

This double-blind, randomized clinical trial was conducted in 2 tertiary hospitals in Spain. Patients 18 years or older undergoing nonemergent cardiac surgery who were at high risk for CSA-AKI were enrolled from June 15, 2016, through November 5, 2021, with follow-up data through February 5, 2022. Of 1156 patients assessed, 343 patients were randomized (1:1) to either receive EBP or standard care.

Intervention

Nonselective EBP device connected to the CPB circuit.

Main Outcomes and Measures

The primary outcome was the rate of CSA-AKI in the 7 days after randomization.

Results

Among 343 patients randomized (169 to receive EBP and 174 to receive usual care), the mean (SD) age was 69 (9) years and 119 were females. The rate of CSA-AKI was 28.4% (95% CI, 21.7%-35.8%) in the EBP group vs 39.7% (95% CI, 32.3%-47.3%) in the standard care group (P = .03), with an adjusted difference of 10.4% (95% CI, 2.3%-18.5%) using a log-binomial model (P = .01). No significant differences (P &amp;gt; .05) were observed in most of the predefined clinical secondary end points or post hoc exploratory end points. In a sensitivity analysis, EBP was found to be more effective in terms of CSA-AKI reduction in patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction (&amp;lt;40%), and lower body mass index (&amp;lt;30). No differences were observed between the groups in adverse events tracking.

Conclusions and Relevance

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 7 days after surgery.

Trial Registration

ClinicalTrials.gov Identifier: NCT02518087