{"id":26994,"date":"2024-10-16T04:58:00","date_gmt":"2024-10-15T20:58:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26994"},"modified":"2024-10-16T05:44:59","modified_gmt":"2024-10-15T21:44:59","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e4%bd%93%e5%a4%96%e8%a1%80%e6%b6%b2%e5%87%80%e5%8c%96%e4%b8%8e%e5%bf%83%e8%84%8f%e5%a4%96%e7%a7%91%e6%9c%af%e5%90%8e%e6%80%a5%e6%80%a7%e8%82%be","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26994","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u4f53\u5916\u8840\u6db2\u51c0\u5316\u4e0e\u5fc3\u810f\u5916\u79d1\u672f\u540e\u6025\u6027\u80be\u635f\u4f24"},"content":{"rendered":"\n

Original Investigation\u00a0| Caring for the Critically Ill Patient<\/p>\n\n\n\n

October 9, 2024<\/p>\n\n\n\n

Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery: The SIRAKI02 Randomized Clinical Trial<\/h1>\n\n\n\n

Xos\u00e9\u00a0P\u00e9rez-Fern\u00e1ndez,\u00a0Arnau\u00a0Ulsamer,\u00a0Mar\u00eda\u00a0C\u00e1mara-Rosell,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online October 9, 2024. doi:10.1001\/jama.2024.20630<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Does the use of a nonselective extracorporeal blood purification (EBP) device connected to the cardiopulmonary bypass circuit reduce the incidence of acute kidney injury (AKI) in high-risk patients undergoing cardiothoracic surgery?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial that included 343 adults, a significant decrease in cardiac surgery\u2013associated AKI was observed in those treated with EBP compared with those who were not (28.4% vs 39.7%).<\/p>\n\n\n\n

Meaning<\/strong>  In high-risk patients undergoing cardiac surgery, the use of a nonselective EBP device was associated with a significant reduction in AKI in the first 7 days after surgery.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Cardiac surgery\u2013<\/strong>associated acute kidney injury (CSA-AKI) remains a significant problem following cardiopulmonary bypass (CPB). Various strategies are proposed to attenuate CSA-AKI, including extracorporeal blood purification (EBP), but little is known about the effect of EBP through an acrylonitrile-sodium methallylsulfonate\/polyethyleneimine membrane during CPB.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether the use of an EBP device in a nonemergent cardiac surgery population reduces CSA-AKI after CPB.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This double-blind, randomized clinical trial was conducted in 2 tertiary hospitals in Spain. Patients 18 years or older undergoing nonemergent cardiac surgery who were at high risk for CSA-AKI were enrolled from June 15, 2016, through November 5, 2021, with follow-up data through February 5, 2022. Of 1156 patients assessed, 343 patients were randomized (1:1) to either receive EBP or standard care.<\/p>\n\n\n\n

Intervention<\/strong>  Nonselective EBP device connected to the CPB circuit.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was the rate of CSA-AKI in the 7 days after randomization.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 343 patients randomized (169 to receive EBP and 174 to receive usual care), the mean (SD) age was 69 (9) years and 119 were females. The rate of CSA-AKI was 28.4% (95% CI, 21.7%-35.8%) in the EBP group vs 39.7% (95% CI, 32.3%-47.3%) in the standard care group (P<\/em>\u2009=\u2009.03), with an adjusted difference of 10.4% (95% CI, 2.3%-18.5%) using a log-binomial model (P<\/em>\u2009=\u2009.01). No significant differences (P<\/em>\u2009>\u2009.05) were observed in most of the predefined clinical secondary end points or post hoc exploratory end points. In a sensitivity analysis, EBP was found to be more effective in terms of CSA-AKI reduction in patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction (<40%), and lower body mass index (<30). No differences were observed between the groups in adverse events tracking.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  The use of a nonselective EBP device connected to the CPB circuit in a nonemergent population of patients undergoing cardiac surgery was associated with a significant reduction of CSA-AKI in the first 7 days after surgery.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT02518087<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation\u00a0| Caring for the Critically Ill […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26994"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26994"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26994\/revisions"}],"predecessor-version":[{"id":26995,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26994\/revisions\/26995"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26994"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26994"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26994"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}