Does the Combination of Aprotinin and Angiotensin-Converting Enzyme Inhibitor Cause Renal Failure After Cardiac Surgery?

Kincaid, Edward H.; Ashburn, David A.; Hoyle, John R.; Reichert, Marc G.; Hammon, John W.; Kon, Neal D.

doi:10.1016/j.athoracsur.2005.03.136

Cited by 83 publications

(43 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, our data show-as does that of others 17 -that the number of packed red blood cells transfused in the intra-and postoperative periods directly and significantly increases the incidence of new onset renal failure (Figure 2). This univariate analysis of the influence of increasing PRBC transfusions on ARF demonstrates the significant direct association between increasing PRBC use and increasing incidence of ARF (PϽ0.0001; ORϭ1.23 per transfused PRBC used).…”

Section: Resultssupporting

confidence: 63%

“…Transfusions in this study increased the risk of ARF in the postcardiac surgery patient by 1.23 times for every unit of PRBC transfused. In the analysis by Kincaid et al, 17 intraoperative transfusions of PRBC were found to significantly increase the risk of nondialysis dependent ARF (defined as a postoperative creatinine greater than 2.0 mg/dL) by 1.04 times per unit of PRBC given. In that study only pre-and intraoperative variables were used, including the number of intraoperative PRBC transfused.…”

Section: Discussionmentioning

confidence: 99%

“…Transfusions of PRBCs have been shown 17 to increase the risk of ARF. Our study confirms this observation.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Aprotinin Does Not Increase the Risk of Renal Failure in Cardiac Surgery Patients

Furnary

Hiratzka

et al. 2007

Circulation

View full text Add to dashboard Cite

Background-Aprotinin is frequently used in high-risk cardiac surgery patients to decrease bleeding complications and transfusions of packed red blood cells (PRBC). Transfusions of PRBC are known to directly increase the risk of new onset postoperative renal failure (ARF) in cardiac surgery patients. A recent highly publicized report implicated aprotinin as an independent causal factor for postoperative renal failure, but ignored the potential confounding affect of numerical PRBC data on ARF. We sought to investigate that claim with an analysis that included all perioperative risk factors for renal failure, including PRBC transfusion data. Methods and Results-Prospectively collected patient data from 12 centers contributing to the Merged Cardiac Registry, an international multicenter cardiac surgery database, operated on between January 2000 and February 2006 were retrospectively analyzed. A previously published risk model for ARF incorporating 12 variables was used to calculate a baseline ARF risk score for each patient in whom those variables were available (nϭ15 174). After adding transfused PRBC data 11 198 patients remained for risk-adjusted assessment of ARF in relation to aprotinin use. Risk-adjusted multivariable analyses were carried out with, and without, consideration of transfused PRBC. Aprotinin was used in 24.6% (2757/11 198). The overall incidence of ARF was 1.6% (180/11 198) and was higher in the aprotinin subset (2.6%, 72/2757 versus 1.3%, 108/8441; PϽ0.001). The incidence of ARF directly and significantly increased with increasing transfusions of PRBC (PϽ0.001). Risk-adjusted analysis without transfused PRBC in the model suggests that aprotinin significantly impacts ARF (Pϭ0.008; ORϭ1.5). However, further risk adjustment with the addition of the highly significant transfused PRBC variable (PϽ0.0001; ORϭ1.23/transfused PRBC) to the model attenuates the purported independent affect of aprotinin (Pϭ0.231) on ARF. Conclusions-The increase in renal failure seen in patients who were administered aprotinin was directly related to increased number of transfusions in that high-risk patient population. Aprotinin use does not independently increase the risk of renal failure in cardiac surgery patients.

show abstract

Section: Resultssupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Aprotinin Does Not Increase the Risk of Renal Failure in Cardiac Surgery Patients

Furnary

Hiratzka

et al. 2007

Circulation

View full text Add to dashboard Cite

show abstract

“…Long-term inhibition of ACE was the only factor that was significantly associated with postoperative AKI. ACEI in combination with aprotonin but not alone was shown to be associated with increased risk for AKI after cardiac surgery (31); however, the definition was different from the modified RIFLE classification. More than half of patients who developed AKI required dialysis, and 48% of patient died, suggesting that those were patients with either stage 2 or stage 3 AKI.…”

Section: Discussionmentioning

confidence: 98%

Preoperative Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Is Associated with Increased Risk for Acute Kidney Injury after Cardiovascular Surgery

Arora¹,

Rajagopalam²,

Ranjan³

et al. 2008

Clinical Journal of the American Society of Nephrology

214

124

View full text Add to dashboard Cite

Background and objectives: Acute kidney injury (AKI) occurs commonly after cardiac surgery. Most patients who undergo cardiac surgery receive long-term treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). The aim of this study was to determine whether long-term use of ACEI/ARB is associated with an increased incidence of AKI after cardiac surgery.Design, setting, participants, & measurements: This was a retrospective cohort study of 1358 adult patients who underwent cardiac surgery between January 1, 2001, and December 31, 2005, in two tertiary care hospitals in Buffalo, NY. The incidence of AKI was determined after cardiac surgery. Clinical data were collected using a standardized form that included comorbid condition, use of ACEI/ARB, and intraoperative and postoperative complications.Results: Overall, 40.2% of patients developed AKI. Preoperative variables that were significantly associated with development of AKI included increasing age; nonwhite race; combined valve surgery and coronary artery bypass grafting compared with coronary artery bypass grafting alone; American Society of Anesthesiologists (ASA) Risk Score category 4/5 compared with 2 to 3; presence of diabetes, congestive heart failure, or neurologic disease at baseline; use of ACEI/ARB; and emergency surgery. Intra-and postoperative factors that were associated with postoperative AKI were hypotension during surgery, use of vasopressors, and postoperative hypotension. Multiple regression logistic model confirmed an independent and significant association of AKI and preoperative use of ACEI/ARB. This was confirmed using a bivariate-probit and propensity score model that adjusts for confounding by indication of use and selection bias.Conclusions: Preoperative use of ACEI/ARB is associated with a 27.6% higher risk for AKI postoperatively. Stopping ACEI or ARB before cardiac surgery may reduce the incidence of AKI.

show abstract

“…Is the described nephrotoxic interaction between angiotensin blockade and aprotinin an independent predictor of renal injury in this study? 3 This consideration is relevant given that 43.9% of the total study cohort were taking preoperative ACE inhibitors. 5.…”

Section: To the Editormentioning

confidence: 99%

Letter by Augoustides Regarding Article, “Risk Index for Perioperative Renal Dysfunction/Failure: Critical Dependence on Pulse Pressure Hypertension”

Augoustides

2007

Circulation

View full text Add to dashboard Cite

Does the Combination of Aprotinin and Angiotensin-Converting Enzyme Inhibitor Cause Renal Failure After Cardiac Surgery?

Cited by 83 publications

References 18 publications

Aprotinin Does Not Increase the Risk of Renal Failure in Cardiac Surgery Patients

Aprotinin Does Not Increase the Risk of Renal Failure in Cardiac Surgery Patients

Preoperative Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Is Associated with Increased Risk for Acute Kidney Injury after Cardiovascular Surgery

Letter by Augoustides Regarding Article, “Risk Index for Perioperative Renal Dysfunction/Failure: Critical Dependence on Pulse Pressure Hypertension”

Contact Info

Product

Resources

About