'Off-pump' heart bypass surgery may reduce risk of postoperative kidney injury, although no improvement in long-term function
Among patients undergoing coronary artery bypass graft (CABG) surgery, those who were not put on a heart-lung machine (off-pump) had a reduced risk of postoperative kidney injury compared to patients who were (on-pump), although there was no evidence of better preserved kidney function by one year after surgery, according to a study in JAMA. The study is being released early online to coincide with its presentation at the European Renal Association-European Dialysis and Transplant Association Congress.
Up to 30 percent of patients develop mild or moderate acute kidney injury (defined as a ≥50 percent increase in serum creatinine concentration) after cardiac surgery. The effects of mild or moderate acute kidney injury on long-term kidney function are not clear, and it has not been proven in any trial that an intervention that reduces the risk of acute kidney injury better preserves longer-term kidney function, according to background information in the study.
Amit X. Garg, M.D., Ph.D., of Western University, London, Ontario, and colleagues conducted a substudy of the Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularization Study (CORONARY), which enrolled patients undergoing CABG surgery and who were randomized to receive the off-pump or on-pump procedure. The substudy included 2,932 patients (from 63 sites in 16 countries). Acute kidney injury within 30 days of surgery was defined as a 50 percent or greater increase in serum creatinine concentration from pre-operative baseline concentration; loss of kidney function at 1 year was defined as a 20 percent or greater loss in estimated glomerular filtration rate (a measure of kidney function) from baseline
The researchers found that there was less acute kidney injury with off-pump (17.5 percent) vs on-pump (20.8 percent) CABG surgery within 30 days. In a subgroup analysis, the absolute risk reduction of acute kidney injury with off-pump vs on-pump CABG surgery was greater in those with chronic kidney disease compared with those without chronic kidney disease.
There was no significant difference between the 2 groups in the loss of kidney function at 1 year (off-pump, 17.1 percent; on-pump, 15.3 percent).
"... the findings emphasize proof is needed to claim an intervention that reduces the risk of mild acute kidney injury better preserves long-term kidney function for the group that received it. This has implications for the development, testing, and use of interventions designed solely to prevent the degrees of acute kidney injury observed in CORONARY, and in determining acceptable adverse effects and costs of such interventions," the authors write.