Division of Nephrology, Seoul National University Bundang Hospital, Seongnam, Korea.
J Korean Med Sci. 2012 May;27(5):506-11. doi: 10.3346/jkms.2012.27.5.506. Epub 2012 Apr 25.
Previous studies reported the beneficial effect of erythropoietin (EPO) in acute injuries. We followed patients with and without acute kidney injury (AKI) after coronary artery bypass grafting (CABG) and evaluated the effect of EPO on long-term outcome. We also assessed the efficacy of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a predictive marker of AKI. Seventy-one patients scheduled for elective CABG were randomly given either 300 U/kg of EPO or saline before CABG. The primary outcome was AKI, and the secondary outcome was the all-cause-mortality and composite of all-cause-mortality and end stage renal disease (ESRD). Twenty-one patients had AKI, 14 (66.7%) in the placebo group and 7 (33.3%) in the EPO group (P = 0.05). Also, uNGAL was higher in the patients with AKI than in those without AKI at baseline, 2, 4, 24, and 72 hr after CABG (P = 0.011). Among patients with AKI, 2-week creatinine (Cr) was not different from baseline Cr in the EPO group, but 2-week Cr was significantly higher than baseline Cr in the placebo group (P = 0.009). All-cause-mortality (P = 0.022) and the composite of all-cause-mortality and ESRD (P = 0.003) were reduced by EPO. EPO reduces all-cause-mortality and ESRD in patients with AKI, largely due to the beneficial effect of EPO on recovery after AKI.
先前的研究报告称促红细胞生成素（EPO）对急性损伤有益。我们随访了接受冠状动脉旁路移植术（CABG）后发生急性肾损伤（AKI）和未发生 AKI 的患者，并评估了 EPO 对长期结局的影响。我们还评估了尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）作为 AKI 预测标志物的功效。71 例行择期 CABG 的患者被随机给予 EPO（300 U/kg）或生理盐水。主要结局是 AKI，次要结局是全因死亡率和全因死亡率与终末期肾病（ESRD）复合终点。21 例患者发生 AKI，安慰剂组 14 例（66.7%），EPO 组 7 例（33.3%）（P=0.05）。另外，AKI 患者的 uNGAL 在基线、CABG 后 2、4、24 和 72 小时均高于无 AKI 患者（P=0.011）。在 AKI 患者中，EPO 组的 2 周肌酐（Cr）与基线 Cr 无差异，但安慰剂组的 2 周 Cr 明显高于基线 Cr（P=0.009）。EPO 降低了 AKI 患者的全因死亡率（P=0.022）和全因死亡率与 ESRD 复合终点（P=0.003）。EPO 降低了 AKI 患者的全因死亡率和 ESRD，主要是因为 EPO 对 AKI 后恢复的有益作用。
