Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery
Authors: Xosé Pérez-Fernández, Arnau Ulsamer, María Cámara-Rosell, Fabrizio Sbraga, Enric Boza-Hernández, Enrique Moret-Ruíz, Erika Plata-Menchaca, Doménech Santiago-Bautista, Patricia Boronat-García, Víctor Gumucio-Sanguino, Judith Peñafiel-Muñoz, Mercedes Camacho-Pérez, Antoni Betbesé-Roig, Lui Forni, Ana Campos-Gómez, Joan Sabater-Riera, Josep Ballus Noguera, Marta Huguet Briba, Rafael Máñez Mendiluce, Francesc Esteve Urbano, Eva Santafosta Gómez, Beymar Henry Alanez Saavedra, Virginia Alonso Juste, Laura Anguela Calvet, Renzo Steve Ávila Espinoza, Paola Cárdenas Campos, Maria Luisa Carrió Cardona, Teodor Casanovas Lorenzo, Luisa Corral Ansa, Vicente Francisco Corral, Elisabet Farrero Bayarri,, Mari Paz Fuset Cabanes, Rosa Granada Vicente, Juan Carlos López Delgado, Neus López Suñe, Krystel Maisterra Santos, Gabriel Jesús Moreno, Eva Oliver Juan, Maria Pons Serra, Elisabet Periche Pedra, Paola Sastre Pérez, Ricard Soley Corderas, David Rodríguez Castro,, Herminia Rosalía Torrado Santos, Maria-Dolores Belda Ley, Fabio Alessandro Di Paolo, Africa Carmen Lores, Stephani-Maria Luna Solis, Ana Rosa Ochagavía Calvo, Pablo Serra Paya, Alejandro Garcia Zaloña, Gemma Via Clavero, Enric Boza Hernández., Albert Gil Dorado, Antonia Bonet Burguera, Esther Mendez Arias, Sara Garcia Ballester, Ariadna Leon Moreno, Raul Senen Herrera, Maite Sanz Iturbe, Jacobo Toscano Fernández, Fabrizio Sbraga, Marcos Potocnik Potocnik, Karina Osorio Higa, Albert Miralles Cassina, Daniel Ortiz Berbel, David Toral Sepúlveda, Arnau Blasco Lucas, Ana Dantas, Belen Cevallos, Javier Tejero, Luis Martinez Sepena, Francis Iglesias Gordillo, María José Bautista Correa, Yolanda Gutiérrez, Elena Modrego Montiel, Carlos Albendea Perell, Jordi Castillo, Elisenda Bruguera, Marga Oliveras, Sara Badia Gamarra, Elisabeth Berastegui Garcia, Olga Torres Aparicio, Mónica Finestres Martin,, Sara Buys, Adrià Escudero Teixidó,, Eva Massó Lago, Frederic Ródenas Gómez, Mónica Rodríguez Núñez, María Teresa Sariñena Fernandez,, Marc Ayala Gallardo, Viridiana Juliette Charlotte Philibert, Marius Sánchez Satorra, Teresa Tomasa Irriguible, Elisabet Angela Valls Estrada, Miguel Hueso, Nuria Montero, Montserrat Estruch, Jordi Ordoñez Llanos, Lluisa Hernandez Platero, Raul Rigo Bonnin, Virginia Mora, Aranzazu Arnaiz Francos, Ana Moreno durán, Maria Elena Farigola Munuera, Cèlia Julià Valls, Albert Gonzalez Pujol, Iluminada Romera Peregrina, Cristina Lerma Brianso, Anna Vera Martinez, Susana Prieto Palomino, Judit Carretero Aguilà, None Querol Parra, Lidia Torà Navarro, Mireia Gonzalez Romero, Leila Gonzalez Barrera, Estefania Puente Mora, Marta Briones Roc, Judit Pérez Sanchez, Cristina Sanz Mellado, Ainoa Garcia-Morron Gallego, Andrea Campoy, Olga Clavería, Sandra Martinez Ocon, Blanca Vazquez Guillamet, Laura Costa Capela, Ingrid Torreguitart, Maria Duran Colacios, Ariadna Puig Aragon, Marta Martinez Orellana, Dolores Perez Soria, Claudia Peribañez Biedma, Sara Gonzalez Del Hoyo, Ariadna Montoya Perez, Mireia Sanchez Escudero, Cristina Mendoza Jimenez, Carolina Mesa Carrizosa, Laia Ibern Navarro, Oscar Lopez Gonzalez, Maria Angeles Burgos Naranjo, Ana Mº Moreno Duran, Pilar Rodriguez Contreras, Virginia Mora Muñiz, Sonia Cabezas Garrido, Agustin CarrionSanchez, Mar Ausio Navarro, Laia Gascon Tomas, Veronica Fuentes Mila, Andrea Chinchilla Perez, Jessica Castaño Camuñez, Rita Nogales Ibañez, Veronica Gimenez Vila, Marta Sanjuan Navais, Daniel Rodriguez Gonzalez, Andrea Gracia Martinez, Virginia Ojeda Jimenez, Soraya Hamed Loukili, Luis Perea Sanchez, Raquel Buendia Flores, Josep Mº Ramos Puig, Clara Piquer Robles, Laura Marti Massanas, Clara Gil Ginebra, Ana Moreno Santoro, Judith Llamas Ruiz, Sandra Hurtado Hidalgo, Marta Pujadas Fernandez-Cordeiro, Aida Barranco Rodriguez, Tania Olivera Rodriguez, Aitor Cardenete Villarroyo, Sandra Cruz Bardina, Silvia Serrano Jaureguizar, Anna Del Rio Sanchez, Marta Llamas Bolta, Carlos Gonzalez Lopez, Rafael Francisco Justel Garcia, Beatriz Ruiz de Pablo, Danela Figuereo Beltre, Claudio Fernandez Gallego, Ignasi Julià Amill, Luis Delgado Ramis, Bernat Romero Ferrer, Regina Roig Pineda, Ana Cabaña Benjumea, Mireia Anglada Oliván, Beatriz Catalán Eraso, Ana Farré Estebe, Victor Ruiz Artola, Esther Bonet Cruces, Eva González Martínez, Marc Fabra Raduà, Jose Maria Manciño Contreras, Sergi Martinez Vega, Laura Raguer Pardo, Victoria Perez González, Mercedes Velázquez Torres, Mieria Diago Ferré, Cristina Blasco Torres, Lara Bielsa Berrocal, Belen Garces Gimeno, Paula Rodriguez Pedreira, Gloria Muñoz del Rio, David Bervel Franco, Javier Rodriguez Fanjul, Eva Benveniste Perez, Fernando Chavez Diandreras, Marta Bauça Socies, Teresa Pons López, David Policarp Mota Montané, Eduardo Enrique Coluccio Pereira
Journal: JAMA (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;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;amp;lt;40%), and lower body mass index (&amp;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