Erythropoietin and Protection of Renal Function in Cardiac Surgery (the EPRICS Trial)
Erythropoietin and Protection of Renal Function in Cardiac Surgery (the EPRICS Trial)
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DOI：
10.1097/aln.0000000000000321
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发表时间：
2014-09-01
期刊：
影响因子：
8.8
通讯作者：
Bjursten, Henrik
中科院分区：
文献类型：
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作者：
Dardashti, Alain;Ederoth, Per;Bjursten, Henrik
背景：到目前为止，还没有已知的预防心脏手术后急性肾损伤的方法。越来越多的证据表明，促红细胞生成素具有肾脏抗凋亡和组织保护作用。然而，最近的人类研究显示了相互矛盾的结果。作者的目的是研究术前单次大剂量促红细胞生成素对术前肾功能受损患者行冠状动脉旁路移植术后肾功能的影响。方法：这项单中心、随机、双盲、安慰剂对照研究包括75例预先存在肾功能损害的患者，根据p-半胱氨酸蛋白酶抑制剂C（15 ml/min）估计肾小球滤过率。患者术前接受单次高剂量促红细胞生成素（400 IU/kg）或安慰剂。主要终点是在术后第3天通过p-半胱氨酸蛋白酶抑制剂C评价的肾保护，与术前值相比。急性肾损伤的发生率和其他肾脏生物标志物的变化是次要终点。结果：术后第三天，两组间相对p-半胱氨酸蛋白酶抑制剂C水平较基线的变化无统计学显著差异，为131 +/- 31%。（平均值+/- SD），对照组为125 +/- 24%（P = 0.31; 95% CI，差异为-0.6至20%）。两组之间的其他肾脏生物标志物或指标（p-中性粒细胞明胶酶相关脂质运载蛋白、p-肌酐、p-尿素和估计的肾小球滤过率）无统计学显著差异。有没有其他的差异，结果变量之间的groups.Conclusion：静脉注射单次高剂量（400 IU/kg）促红细胞生成素没有肾保护作用的患者肾功能降低接受冠状动脉搭桥手术。
Background: To date, there are no known methods for preventing acute kidney injury after cardiac surgery. Increasing evidence suggests that erythropoietin has renal antiapoptotic and tissue protective effects. However, recent human studies have shown conflicting results. The authors aimed to study the effect of a single high-dose erythropoietin preoperatively on renal function after coronary artery bypass grafting in patients with preoperative impaired renal function.Methods: This single-center, randomized, double-blind, placebo-controlled study included 75 patients scheduled for coronary artery bypass grafting with preexisting renal impairment estimated glomerular filtration rate based on p-cystatin C (15 ml/min). The patients either received a single high-dose erythropoietin (400 IU/kg) or placebo preoperatively. The primary endpoint was renal protection evaluated by p-cystatin C at the third postoperative day compared to the preoperative values. Incidence of acute kidney injury and other renal biomarker changes were among secondary endpoints.Results: There was no statistically significant difference on the third postoperative day for relative p-cystatin C level changes from baseline between the groups, 131 +/- 31% (mean +/- SD) for the study group and 125 +/- 24% for the control group (P = 0.31; 95% CI, -0.6 to 20% for the difference). There were no statistically significant differences in other renal biomarkers or measures between the groups (p-neutrophil gelatinase-associated lipocalin, p-creatinine, p-urea, and estimated glomerular filtration rate). There were no other differences in outcome variables between the groups.Conclusion: Intravenous administration of a single high-dose (400 IU/kg) erythropoietin did not have a renal protective effect on patients with reduced kidney function undergoing coronary artery bypass surgery.