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Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump: a randomized controlled trial.
Garg, Amit X; Chan, Matthew T V; Cuerden, Meaghan S; Devereaux, P J; Abbasi, Seyed Hesameddin; Hildebrand, Ainslie; Lamontagne, François; Lamy, Andre; Noiseux, Nicolas; Parikh, Chirag R; Perkovic, Vlado; Quantz, Mackenzie; Rochon, Antoine; Royse, Alistair; Sessler, Daniel I; Shah, Pallav J; Sontrop, Jessica M; Tagarakis, Georgios I; Teoh, Kevin H; Vincent, Jessica; Walsh, Michael; Yared, Jean-Pierre; Yusuf, Salim; Whitlock, Richard P.
Afiliación
  • Garg AX; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Chan MTV; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Cuerden MS; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Devereaux PJ; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Abbasi SH; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Hildebrand A; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Lamontagne F; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Lamy A; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Noiseux N; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Parikh CR; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Perkovic V; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Quantz M; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Rochon A; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Royse A; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Sessler DI; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Shah PJ; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Sontrop JM; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Tagarakis GI; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Teoh KH; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Vincent J; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Walsh M; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Yared JP; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Yusuf S; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
  • Whitlock RP; Division of Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive Care (Chan), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Departments of Health Research Methods, Evid
CMAJ ; 191(9): E247-E256, 2019 03 04.
Article en En | MEDLINE | ID: mdl-30833491
BACKGROUND: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. METHODS: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater (≥ 26.5 µmol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery. RESULTS: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease. INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery. Trial registration: ClinicalTrials.gov, no. NCT00427388.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Metilprednisolona / Puente Cardiopulmonar / Lesión Renal Aguda / Glucocorticoides / Procedimientos Quirúrgicos Cardíacos / Antiinflamatorios Tipo de estudio: Clinical_trials / Etiology_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: CMAJ Asunto de la revista: MEDICINA Año: 2019 Tipo del documento: Article Pais de publicación: Canadá
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Metilprednisolona / Puente Cardiopulmonar / Lesión Renal Aguda / Glucocorticoides / Procedimientos Quirúrgicos Cardíacos / Antiinflamatorios Tipo de estudio: Clinical_trials / Etiology_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: CMAJ Asunto de la revista: MEDICINA Año: 2019 Tipo del documento: Article Pais de publicación: Canadá