Prophylaxis with erythropoietin versus placebo reduces acute kidney injury and neutrophil gelatinase-associated lipocalin in patients undergoing cardiac surgery: a randomized, double-blind controlled trial

Adis Tasanarong, Soodkate Duangchana, Sangduen Sumransurp, Boonlawat Homvises, Opas Satdhabudha, Adis Tasanarong, Soodkate Duangchana, Sangduen Sumransurp, Boonlawat Homvises, Opas Satdhabudha

Abstract

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication following coronary bypass graft (CABG) surgery. Multi-factorial causes of CSA-AKI involve oxidative stress and inflammation. Erythropoietin (EPO) has been shown from many studies to have a reno-protective effect. The present study was conducted to examine the role of EPO in preventing CSA-AKI.

Methods: This prospective, randomized, double-blind, placebo-controlled trial was conducted in the Cardiovascular and Thoracic Unit. One hundred patients randomly received either 200 U/kg of rHuEPO (n = 50) or saline (n = 50) intravenously three days before operation, and rHuEPO 100 U/kg or saline at operation time. The serum creatinine (SCr), estimated glomerular filtration rate (eGFR) and urine neutrophil gelatinase-associated lipocaline (NGAL) were measured in order to evaluate renal injury following CABG.

Results: The incidence of CSA-AKI was significantly lower in rHuEPO group (14%) when compared with the placebo group (38%; p < 0.01). The mean intensive care unit (ICU) and hospital stays of the rHuEPO group were significantly shorter than the placebo group (p < 0.01). Postoperative increases in SCr and decreases in eGFR were significantly lower in the rHuEPO group than the placebo group (p < 0.05). The mean urine NGAL in rHuEPO group was significantly lower than the placebo group at 3 hr, 6 hr, 12 hr and 18 hr after CABG (p < 0.05), respectively.

Conclusions: Prophylaxis administration with intravenous rHuEPO before cardiac surgery decreased the incidence of CSA-AKI and urine NGAL with reduced days in ICU and hospital in elective CABG patients.

Trial registration: ClinicalTrials.gov: NCT01066351.

Figures

Figure 1
Figure 1
Flow diagram on enrollment of patients into the study.
Figure 2
Figure 2
Mean changes of SCr (2A) and eGFR (2B) at day 1 (D1), day 2 (D2), and day 3 (D3) after operation compared with baseline in patients randomized to placebo (black line) or rHuEPO (gray line). *p < 0.05 compared between the placebo and rHuEPO group.

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