Effect of a Single Bolus of Erythropoietin on Renoprotection in Patients Undergoing Thoracic Aortic Surgery With Moderate Hypothermic Circulatory Arrest

Kim, Ji Eun; Song, Suk-Won; Kim, Jong Yeop; Lee, Hyun Joo; Chung, Kum-Hee; Shim, Yon Hee

doi:10.1016/j.athoracsur.2015.08.007

Cited by 22 publications

(30 citation statements)

References 27 publications

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“…In 2 recent RCTs in which patients were randomized to a liberal (Hg <9.5 g/dL) or restrictive (Hg <7.5 g/dL) transfusion policy intraoperatively and postoperatively, there was no difference in postoperative outcomes including AKI . In addition, studies have failed to demonstrate any benefit in the use of erythropoietin in the prevention of postoperative AKI . Conventional ultrafiltration has been used to treat the hemodilutional effects of CPB circuits, but routine adoption does not seem to be efficacious, with a recent study demonstrating a higher adjusted risk of AKI …”

Section: Resultsmentioning

confidence: 99%

“…Perioperative. Numerous pharmacological agents including levosimendan, [94][95][96][97] statins, 98-100 N-acetylcysteine, [101][102][103][104] sodium bicarbonate, [105][106][107][108] and erythropoietin [109][110][111][112][113] have, for the most part, failed to demonstrate benefit for the prevention of CS-AKI. A possible exception is dexmedetomidine, for which a number of small or low-quality studies found a reduction in the occurrence of AKI after cardiac surgery.…”

Section: Pharmacological Strategiesmentioning

confidence: 99%

“…193,194 In addition, studies have failed to demonstrate any benefit in the use of erythropoietin in the prevention of postoperative AKI. [109][110][111] Conventional ultrafiltration has been used to treat the hemodilutional effects of CPB circuits, but routine adoption does not seem to be efficacious, with a recent study demonstrating a higher adjusted risk of AKI. 195 As discussed, the effect of RIPC on renal function yields conflicting results.…”

Section: Nonpharmacological Strategiesmentioning

confidence: 99%

See 2 more Smart Citations

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Nadim

Forni

Bïhorac

et al. 2018

JAHA

218

191

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Section: Resultsmentioning

confidence: 99%

Section: Pharmacological Strategiesmentioning

confidence: 99%

Section: Nonpharmacological Strategiesmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Nadim

Forni

Bïhorac

et al. 2018

JAHA

218

191

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“…It should, however, be emphasized that in the largest study in ICU patients [215] AKI was only reported as an adverse effect and not clearly defined. Two more recent RCTs in the setting of thoracic aortic surgery [217] and contrast administration in diabetics [218] confirmed the absence of beneficial effect of EPO on the incidence of AKI or need for RRT in critically ill patients (ESM_2 Table S12).…”

Section: Hormonal Manipulationmentioning

confidence: 97%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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“…The opposing results can possibly be attributed to lack of biopsied samples and the inherent variability in injury severity and outcome. Other human studies have conducted prophylactic administration of EPO and Pentoxifylline in patients undergoing cardiac surgery, a procedure with a high risk of inducing AKI [42][43][44][45][46]. In these studies, positive outcomes were associated with decreased inflammatory markers, including lower urinary NGAL, TNF α, IL-6, and C-reactive protein [42,46].…”

Section: Macrophage Polarization In Human Akimentioning

confidence: 99%

The role of macrophages during acute kidney injury: destruction and repair

et al. 2018

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Acute kidney injury (AKI) is defined by a rapid decline in renal function. Regardless of the initial cause of injury, the influx of immune cells is a common theme during AKI. While an inflammatory response is critical for the initial control of injury, a prolonged response can negatively affect tissue repair. In this review, we focus on the role of macrophages, from early inflammation to resolution, during AKI. These cells serve as the innate defense system by phagocytosing cellular debris and pathogenic molecules and bridge communication with the adaptive immune system by acting as antigen-presenting cells and secreting cytokines. While many immune cells function to initiate inflammation, macrophages play a complex role throughout AKI. This complexity is driven by their functional plasticity: the ability to polarize from a "pro-inflammatory" phenotype to a "pro-reparative" phenotype. Importantly, experimental and translational studies indicate that macrophage polarization opens the possibility to generate novel therapeutics to promote repair during AKI. A thorough understanding of the biological roles these phagocytes play during both injury and repair is necessary to understand the limitations while furthering the therapeutic application.

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Effect of a Single Bolus of Erythropoietin on Renoprotection in Patients Undergoing Thoracic Aortic Surgery With Moderate Hypothermic Circulatory Arrest

Cited by 22 publications

References 27 publications

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

The role of macrophages during acute kidney injury: destruction and repair

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