Department of Internal Medicine and Kidney Research Institute, Hallym University College of Medicine, Anyang, Korea.
Am J Nephrol. 2009;30(3):253-60. doi: 10.1159/000223229. Epub 2009 Jun 2.
BACKGROUND/AIMS: Depending on the specific definition, acute kidney injury (AKI) occurs in 7-40% of patients undergoing cardiac surgery. Even small changes in serum creatinine (SCr) levels are associated with increased mortality after cardiac surgery. However, there are no current methods for preventing AKI after cardiac surgery. Erythropoietin (EPO) has been shown to elicit tissue-protective effects in various experimental models. In this pilot trial, we evaluated the effectiveness of EPO in the prevention of AKI after coronary artery bypass grafting (CABG).
71 patients scheduled for elective CABG randomly received either 300 U/kg of EPO or saline intravenously before surgery. AKI was defined as a 50% increase in SCr levels over baseline within the first 5 postoperative days. Estimated glomerular filtration rate (eGFR) was calculated from the Cockcroft-Gault equation.
Of 71 patients, 13 developed postoperative AKI: 3 of the 36 patients in the EPO group (8%) and 10 of the 35 patients in the placebo group (29%; p = 0.035). The increase in postoperative SCr concentration and the decline in postoperative eGFR were significantly lower in the EPO group than in the placebo group.
In our small, pilot trial, prophylactic administration of EPO prevents AKI and improves postoperative renal function. These data are preliminary and require confirmation in a larger clinical trial.
背景/目的：根据具体定义，接受心脏手术的患者中有 7-40%发生急性肾损伤（AKI）。即使血清肌酐（SCr）水平略有变化，也与心脏手术后死亡率增加相关。然而，目前尚无预防心脏手术后 AKI 的方法。促红细胞生成素（EPO）已在各种实验模型中显示出具有组织保护作用。在这项初步试验中，我们评估了 EPO 在预防冠状动脉旁路移植术（CABG）后 AKI 中的有效性。
71 例行择期 CABG 的患者随机接受术前静脉内给予 300 U/kg 的 EPO 或生理盐水。AKI 的定义为术后 5 天内 SCr 水平较基线升高 50%。估算肾小球滤过率（eGFR）根据 Cockcroft-Gault 方程计算。
71 例患者中，13 例发生术后 AKI：EPO 组 36 例患者中的 3 例（8%）和安慰剂组 35 例患者中的 10 例（29%；p = 0.035）。EPO 组术后 SCr 浓度升高和术后 eGFR 下降均明显低于安慰剂组。
在我们的小型初步试验中，预防性给予 EPO 可预防 AKI 并改善术后肾功能。这些数据是初步的，需要在更大的临床试验中得到证实。
