by Paul Mayne
(Medical Xpress)—Among patients undergoing coronary artery bypass graft (CABG) surgery, those who were not put on a heart-lung machine (off-pump) had a reduced risk of postoperative kidney injury compared to patients who were (on-pump), although there was no evidence of better preserved kidney function by one year after surgery, according to a Western-led study published in the June 4 issue of the Journal of the American Medical Association.
Led by Schulich School of Medicine & Dentistry professor Dr. Amit X. Garg, the study is being released early online to coincide with the European Renal Association-European Dialysis and Transplant Association Congress.
Schulich colleague Dr. Richard Novick was also among the paper's co-authors.
Up to 30 percent of patients develop mild or moderate acute kidney injury after cardiac surgery. The effects of mild or moderate acute kidney injury on long-term kidney function are not clear, and it has not been proven in any trial that an intervention that reduces the risk of acute kidney injury better preserves longer-term kidney function, according to background information in the study.
The international team of researchers conducted a substudy of the Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularization Study (CORONARY), which enrolled patients undergoing CABG surgery and who were randomized to receive the off-pump or on-pump procedure. The substudy included 2,932 patients (from 63 sites in 16 countries).
The researchers found less acute kidney injury with off-pump (17.5 per cent) versus on-pump (20.8 per cent) CABG surgery within 30 days. In a subgroup analysis, the absolute risk reduction of acute kidney injury with off-pump versus on-pump CABG surgery was greater in those with chronic kidney disease compared with those without chronic kidney disease.
There was no significant difference between the 2 groups in the loss of kidney function at one year (off-pump, 17.1 per cent; on-pump, 15.3 per cent).
"The findings emphasize proof is needed to claim an intervention that reduces the risk of mild acute kidney injury better preserves long-term kidney function for the group that received it," the authors wrote. "This has implications for the development, testing, and use of interventions designed solely to prevent the degrees of acute kidney injury observed in CORONARY, and in determining acceptable adverse effects and costs of such interventions."
Explore further: Personalized fluid levels cuts acute kidney injury
More information: Garg AX, Devereaux PJ, Yusuf S, et al. "Kidney Function After Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial." JAMA. 2014;311(21):2191-2198. DOI: 10.1001/jama.2014.4952.
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by Paul Mayne
(Medical Xpress)—Among patients undergoing coronary artery bypass graft (CABG) surgery, those who were not put on a heart-lung machine (off-pump) had a reduced risk of postoperative kidney injury compared to patients who were (on-pump), although there was no evidence of better preserved kidney function by one year after surgery, according to a Western-led study published in the June 4 issue of the Journal of the American Medical Association.
Led by Schulich School of Medicine & Dentistry professor Dr. Amit X. Garg, the study is being released early online to coincide with the European Renal Association-European Dialysis and Transplant Association Congress.
Schulich colleague Dr. Richard Novick was also among the paper's co-authors.
Up to 30 percent of patients develop mild or moderate acute kidney injury after cardiac surgery. The effects of mild or moderate acute kidney injury on long-term kidney function are not clear, and it has not been proven in any trial that an intervention that reduces the risk of acute kidney injury better preserves longer-term kidney function, according to background information in the study.
The international team of researchers conducted a substudy of the Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularization Study (CORONARY), which enrolled patients undergoing CABG surgery and who were randomized to receive the off-pump or on-pump procedure. The substudy included 2,932 patients (from 63 sites in 16 countries).
The researchers found less acute kidney injury with off-pump (17.5 per cent) versus on-pump (20.8 per cent) CABG surgery within 30 days. In a subgroup analysis, the absolute risk reduction of acute kidney injury with off-pump versus on-pump CABG surgery was greater in those with chronic kidney disease compared with those without chronic kidney disease.
There was no significant difference between the 2 groups in the loss of kidney function at one year (off-pump, 17.1 per cent; on-pump, 15.3 per cent).
"The findings emphasize proof is needed to claim an intervention that reduces the risk of mild acute kidney injury better preserves long-term kidney function for the group that received it," the authors wrote. "This has implications for the development, testing, and use of interventions designed solely to prevent the degrees of acute kidney injury observed in CORONARY, and in determining acceptable adverse effects and costs of such interventions."
Explore further: Personalized fluid levels cuts acute kidney injury
More information: Garg AX, Devereaux PJ, Yusuf S, et al. "Kidney Function After Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial." JAMA. 2014;311(21):2191-2198. DOI: 10.1001/jama.2014.4952.
Medical Xpress on facebook
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May 17, 2012
One type of open heart surgery is likely safer than the other for chronic kidney disease (CKD) patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
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May 28, 2014
(HealthDay)—A new fluid protocol is safe and effective in preventing contrast-induced acute kidney injury in patients undergoing cardiac catheterization, according to a study published in the May 24 issue ...
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Dec 20, 2013
Following cardiac surgery, patients with elevated levels of kidney injury biomarkers are at a significantly higher risk of dying during the next three years, a Yale study has found. The results appear in ...
BMC surgeon recommends off-pump coronary artery bypass grafting be abandoned
Jul 22, 2013
In a Special Report in the current issue of Circulation, Boston Medical Center cardiothoracic surgeon Harold Lazar, MD, has found that off-pump coronary artery bypass graft (OPCAB) surgery has failed to show any significant improv ...
Acute kidney injury may be a risk factor for later heart problems
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Patients who experience abrupt kidney injury following surgery have an increased risk of later developing heart problems, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN) ...
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