Intraoperative Methylprednisolone During Bypass Not Renal Protective
No decrease in acute kidney injury seen with intraoperative steroids during cardiopulmonary bypass
MONDAY, March 4, 2019 (Pharmacist's Briefing) -- For patients undergoing cardiac surgery with a cardiopulmonary bypass pump, administration of intravenous methylprednisolone does not reduce the risk for acute kidney injury, according to a study published online March 4 in CMAJ, the journal of the Canadian Medical Association.
Amit X. Garg, M.D., Ph.D., from the London Health Sciences Centre in Ontario, Canada, and colleagues conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass from 79 centers in 18 countries. A total of 7,286 patients were randomly assigned to receive either intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo.
The researchers found that 40.6 percent of 3,647 patients in the methylprednisolone group and 39.2 percent of 3,639 patients in the placebo group had acute kidney injury (adjusted relative risk, 1.04; 95 percent confidence interval, 0.96 to 1.11). Consistent results were seen across definitions of acute kidney injury and among patients with preoperative chronic kidney disease.
"Administering steroids to prevent inflammation during surgery did not reduce the risk of acute kidney injury in people at moderate or high risk of adverse effects," Garg said in a statement. "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."
Several authors disclosed financial ties to the pharmaceutical industry.