Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University Salzburg, 5020, Salzburg, Austria.
Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
BMC Anesthesiol. 2024 Oct 7;24(1):357. doi: 10.1186/s12871-024-02680-w.
Desmopressin acetate (1-deamino-8-d-arginine vasopressin-DDAVP) is a analogue of the antidiuretic hormone vasopressin. DDAVP is suggested to reduce bleeding after cardiac surgery using cardiopulmonary bypass. The aim of this study was to determine if DDAVP has any negative impact on renal function leading to acute kidney injury (AKI) and therefore increases the need for renal replacement therapy (RRT).
We performed a retrospective single institutional cohort analysis of 2,179 patients undergoing elective and urgent cardiac surgery with CPB from 2017 to 2021. Logistic regression analysis was used to investigate any association between DDAVP, the incidence of AKI KDIGO class 3 and the need for RRT, respectively. The model was adjusted for relevant covariates, including preexisting renal impairment, pharmacological hemodynamic support with vasopressors, complexity of the surgery and postoperative lactate. Secondary outcomes included, in hospital mortality and the need for allogenic blood transfusion.
A total of 992 (45.5%) patients received DDAVP intraoperatively during surgery or shortly thereafter. The use of DDAVP was associated with a significant increase in in AKI KDIGO class 3 (OR 2.27; 95% CI 1.46-3.55; p < 0,001) and the need for RRT (OR 2.19; 95%CI 1.48-3.24; p < 0,001). Both findings persisted after covariate adjusting. No increased in-hospital mortality was associated with DDAVP.
In cardiac surgery, the use of DDAVP was associated with an increased rate of server AKI and the requirement for RRT. Given the severity of the potential harm associated with DDAVP, an evidence-based reevaluation is needed to enable an accurate risk and benefit assessment.
醋酸去氨加压素（1-脱氨基-8-D-精氨酸血管加压素-DDAVP）是抗利尿激素血管加压素的类似物。DDAVP 被建议用于减少体外循环心脏手术后的出血。本研究的目的是确定 DDAVP 是否对肾功能有任何负面影响，导致急性肾损伤（AKI），从而增加肾脏替代治疗（RRT）的需求。
我们对 2017 年至 2021 年期间接受体外循环心脏手术的 2179 例择期和紧急心脏手术患者进行了回顾性单机构队列分析。使用逻辑回归分析分别研究 DDAVP 与 AKI KDIGO 3 级的发生率和 RRT 的需求之间的任何关联。该模型调整了相关协变量，包括术前肾功能不全、血管加压素等药理学血液动力学支持、手术的复杂性和术后乳酸。次要结局包括住院死亡率和异体输血的需求。
共有 992 例（45.5%）患者在手术期间或之后不久接受了 DDAVP 术中治疗。使用 DDAVP 与 AKI KDIGO 3 级（OR 2.27；95%CI 1.46-3.55；p<0.001）和 RRT 的需求（OR 2.19；95%CI 1.48-3.24；p<0.001）显著增加相关。在调整协变量后，这两种发现仍然存在。与 DDAVP 相关的住院死亡率无增加。
在心脏手术中，使用 DDAVP 与严重 AKI 发生率增加和 RRT 需求增加相关。鉴于与 DDAVP 相关的潜在危害的严重程度，需要进行基于证据的重新评估，以实现对风险和获益的准确评估。
