Blood transfusion and acute kidney injury after cardiac surgery: a retrospective observational study.

IF 3.3 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2025-07-29 DOI:10.1007/s12630-025-03036-9

Yuliya Boyko, Sebastian B Rasmussen, Justyna Bartoszko, Wilton A van Klei, Stuart McCluskey, Keyvan Karkouti, Hanne B Ravn

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引用次数: 0

Abstract

Purpose: Cardiac surgery-associated acute kidney injury (AKI) is linked to poor outcomes. An observational study from Copenhagen, Denmark identified perioperative red blood cell (RBC) transfusion as a modifiable risk factor for AKI, with a dose-dependent relationship between the number of RBC units transfused and the occurrence and severity of AKI. We aimed to externally validate those findings in a larger population.

Methods: We conducted a retrospective observational study of adult patients undergoing nonemergent on-pump cardiac surgery at Toronto General Hospital (Toronto, ON, Canada) between 2016 and 2021. Acute kidney injury was classified using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data were analyzed using inverse probability weighted logistic regression.

Results: Among 5,204 patients, 798 developed AKI, with 77% classified as stage 1, 11% as stage 2, and 12% as stage 3. Patients with AKI were older, had lower preoperative hemoglobin levels and estimated glomerular filtration rates, longer cardiopulmonary bypass duration, and lower intraoperative hemoglobin levels. Red blood cells were administered to 37% of patients, with 14% receiving plasma and 32% platelets. Only RBC transfusion, alone or combined with other blood products, was significantly associated with AKI. The transfusion of 1-2 RBC units increased the probability of stage 1 AKI by 4% and stage 2-3 AKI by 2% compared with patients not receiving RBCs. The risk was especially pronounced with the transfusion of > 2 units of RBCs, which raised the probability of stage 1 AKI by 12% and stage 2-3 AKI by 9%.

Conclusions: This study confirms previous findings that RBC transfusion is associated with postoperative AKI in cardiac surgery patients. The association was strongest among patients who received > 2 units of RBCs. Prospective studies are needed to determine the optimal strategies for transfusion in these patients and evaluate potential alternatives.

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心脏手术后输血与急性肾损伤：一项回顾性观察研究。

目的：心脏手术相关急性肾损伤（AKI）与不良预后相关。丹麦哥本哈根的一项观察性研究发现，围手术期红细胞（RBC）输血是AKI的一个可改变的危险因素，输血红细胞单位数与AKI的发生和严重程度之间存在剂量依赖关系。我们的目标是在更大的人群中外部验证这些发现。方法：我们对2016年至2021年间在多伦多综合医院（Toronto General Hospital， ON, Canada）接受非紧急心脏泵手术的成年患者进行了回顾性观察研究。使用肾脏疾病：改善全球预后（KDIGO）标准对急性肾损伤进行分类。数据分析采用逆概率加权逻辑回归。结果：5204例患者中，798例发展为AKI，其中77%为1期，11%为2期，12%为3期。AKI患者年龄较大，术前血红蛋白水平和肾小球滤过率较低，体外循环时间较长，术中血红蛋白水平较低。37%的患者接受红细胞治疗，14%接受血浆治疗，32%接受血小板治疗。只有单独或联合其他血液制品输血与AKI显著相关。与不接受红细胞的患者相比，输注1-2个红细胞单位的患者发生1期AKI的概率增加了4%，2-3期AKI的概率增加了2%。输血bb20单位红细胞的风险尤其明显，使1期AKI的概率增加12%，2-3期AKI的概率增加9%。结论：本研究证实了先前的研究结果，即RBC输血与心脏手术患者术后AKI相关。这种关联在接受bb20单位红细胞的患者中最为明显。需要前瞻性研究来确定这些患者输血的最佳策略并评估潜在的替代方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.