Effect of restrictive blood transfusion on postoperative acute kidney injury after total hip replacement arthroplasty: a prospective randomized controlled trial

Corresponding author Hyo Jung Son Department of Anesthesiology and Pain Medicine, National Police Hospital, Songee-ro 123, Songpagu, Seoul 05715, Korea Tel: +82-2-3400-1492 Fax: +82-2-3400-1249 E-mail: gidget80@police.go.kr ORCID: http://orcid.org/0000-0001-7710-7605 Blood transfusion is an important method of fluid management and benefits patients when properly used; however, it involves the risk of side effects such as critical organ damage. This study was designed to evaluate the efficacy and safety of a restrictive transfusion strategy (transfusion threshold of hemoglobin 8 g/dL) compared to a conventional transfusion strategy (transfusion threshold of hemoglobin 10 g/dL) on postoperative AKI among patients undergoing total hip replacement arthroplasty (THRA). Patients undergoing THRA were divided into two groups: restrictive transfusion strategy (n=72) and conventional transfusion strategy (n=72). Stroke volume variation was performed to maintain methods, complications, and preoperative and postoperative laboratory tests. They were categorized according to changes in plasma creatinine (Cr) concentration within 48 hours after THRA using Acute Kidney Injury Network criteria. Acute kidney injury (AKI) occurred in three patients (4.2%) in the restrictive transfusion strategy group and two patients (2.8%) in the conventional transfusion strategy group (p=0.99). The mean serum Cr levels 48 hours after surgery were 0.76±0.36 and 0.66±0.20 mg/dL in the restrictive transfusion strategy group and the conventional transfusion strategy group, respectively (p=0.30). Perioperative restrictive transfusion or conventional transfusion in patients undergoing elective THRA is not related to AKI when maintaining proper volume status during surgery.