The impact of hemoadsorption in patients with chronic kidney disease undergoing coronary artery bypass grafting.

Background: With an annual incidence of up to 30%, cardiac surgery-associated acute kidney injury (CSA-AKI) may be one of the most underestimated yet common complications, hence reno-protective interventions are critical. We evaluated the impact of hemoadsorption (HA) on clinical outcomes in KDIGO (Kidney Disease: Improving Global Outcomes) G2/A2 patients (GFR 60-89 ml/min/1.73 m² and 30-300 mg/g albuminuria) undergoing coronary artery bypass grafting (CABG).

Method: Forty patients with chronic kidney disease (KDIGO G2/A2) were treated with intraoperative HA therapy during CABG surgery (HA group) and were compared with 40 propensity-score matched control CABG patients without intraoperative HA (control group). Primary endpoints were the need for renal replacement therapy (RRT) and/or worsening of the KDIGO stage during the perioperative period. Secondary endpoints included changes in inflammatory biomarkers, vasopressor use, and ICU/hospital stay.

Results: No significant differences were observed in demographics between groups. Worsened KDIGO stages were more frequent in the control group (P = .04), and the HA group had less RRT use and shorter ICU stays (P = .02 and P = .03). On the first postoperative day, levels of serum creatinine (1.85 ± 0.6 vs 2.75 ± 0.6 mg/dl; P = .035), myoglobin (210±75 vs 310 ± 80 μg/l; P = .04), NT-proBNP (130 ± 30 vs 180 ± 40 pg/ml; P = .04), IL-6 (8.2±4 vs 22.2 ± 4 pg/ml; P = .012), procalcitonin (1.4 ± 0.1 vs 1.76 ± 0.2 μg/l, P = .02), C-reactive protein (7.6 ± 2 vs 14.2 ± 4 mg/l, P = .01), and D-dimer (0.76 ± 0.04 vs 2.2 ± 0.07 mg/l, P = .002) were significantly lower in the HA group.

Conclusion: This pioneering study highlights the potential benefits of HA in mitigating kidney function and inflammation in CABG patients with borderline chronic kidney disease. These findings require validation in large, multicenter trials.