The Use of Steroids is Ineffective at Preventing Kidney Injury During Cardiac Bypass Surgery

For patients undergoing cardiopulmonary bypass surgery, being administered intravenous steroids does not mitigate their risk of developing acute kidney injury, according to a study published in the Canadian Medical Association Journal (CMAJ).

It is estimated that of the 4 million annual cardiopulmonary bypass surgeries performed worldwide, about 20% are complicated by the onset of acute kidney injury, defined as a rapid decline in kidney function. This adverse occurrence is associated with longer hospital stays, augmented health care costs, and death. In extreme cases, acute kidney disease patients may require the use of dialysis to sustain life. Because currently, an intervention that can be implemented to decrease the risk of acute kidney injury has proven evasive, researchers sought to test the efficacy of steroid therapy being utilized on patients undergoing a cardiopulmonary bypass.

Enlisting the Trial Subjects

The researchers for this international study recruited 7,286 patients from 79 centers across 18 countries (Canada, China, India, United States, Colombia, Australia, Italy, Iran, Czech Republic, Greece, Spain, Brazil, Austria, Belgium, Hong Kong, Argentina, Chile, and Ireland), and conducted a prespecified sub-study of a randomized controlled trial. They set eligibility criteria to include moderate-to-high risk of perioperative death on a score of six or greater based on the European System for Cardiac Operative Risk Evaluation. Patients were arbitrarily assigned (1:1) to receive either the intravenous steroid, methylprednisolone (250 mg at anesthetic induction and 250 mg at start of cardiopulmonary bypass), or a placebo. Caregivers, patients, data collectors and outcome analyzers were all appraised of the assigned intervention. The primary study outcome of interest was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration of 0.3 mg/dL or greater, or 50% or greater in the 14-day period post-surgery, or the post-surgery use of a dialysis machine within 30 days.

Steroid use during cardiac bypass surgery did not reduce risk of severe kidney injury https://t.co/3zH0mkf1KF

— TheBiotechTimes (@BiotechTimes) March 4, 2019

Steroids Do Not Reduce Risk to Kidneys

The trial disclosed that acute kidney injury occurred in 40.6% (n=3,647) patients in the steroid group, compared to 39.2% (n=3,3639) patients in the placebo control (adjusted RR=1.04; 95% CI, 0.96 to 1.11). These results were consistently displayed across several definitions of acute kidney injury and in patients with chronic, preoperative kidney disease.

“Given the broad range of countries and populations represented in the study, these findings further support a shift away from using steroids as an effective method of preventing the complications from inflammation during bypass surgery,” says study author Dr. Amit Garg, a scientist at Lawson Health Research Institute and professor at Schulich School of Medicine & Dentistry, Western University, London, Ontario, said in a press release. While providing a summation of their findings, they would continue by remarking, “the lack of evidence of a protective effect of steroids combined with some adverse effects that prophylactic use of steroids during cardiopulmonary bypass surgery is not warranted.”

Steroid use during cardiac bypass #surgery did not reduce risk of severe #kidney injury @CMAJ @CMAJ https://t.co/93Y0PSu1yp

— Medical Xpress (@physorg_health) March 4, 2019

Steroid use during cardiac bypass surgery did not reduce risk of severe kidney injury https://t.co/UorWph5ss5

— healthmedicinet (@healthmedicinet) March 4, 2019