Post-op kidney risk reduced in 'off-pump' patients

June 4, 2014 by Paul Mayne, University of Western Ontario

(Medical Xpress)—Among patients undergoing coronary artery bypass graft (CABG) surgery, those who were not put on a heart-lung machine (off-pump) had a reduced risk of postoperative kidney injury compared to patients who were (on-pump), although there was no evidence of better preserved kidney function by one year after surgery, according to a Western-led study published in the June 4 issue of the Journal of the American Medical Association.

Led by Schulich School of Medicine & Dentistry professor Dr. Amit X. Garg, the study is being released early online to coincide with the European Renal Association-European Dialysis and Transplant Association Congress.

Schulich colleague Dr. Richard Novick was also among the paper's co-authors.

Up to 30 percent of develop mild or moderate acute kidney injury after cardiac surgery. The effects of mild or moderate acute kidney injury on long-term kidney are not clear, and it has not been proven in any trial that an intervention that reduces the risk of acute kidney injury better preserves longer-term kidney function, according to background information in the study.

The international team of researchers conducted a substudy of the Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularization Study (CORONARY), which enrolled patients undergoing CABG surgery and who were randomized to receive the off-pump or on-pump procedure. The substudy included 2,932 patients (from 63 sites in 16 countries).

The researchers found less acute kidney injury with off-pump (17.5 per cent) versus on-pump (20.8 per cent) CABG surgery within 30 days. In a subgroup analysis, the absolute risk reduction of acute kidney injury with off-pump versus on-pump CABG surgery was greater in those with chronic kidney disease compared with those without chronic kidney disease.

There was no significant difference between the 2 groups in the loss of kidney function at one year (off-pump, 17.1 per cent; on-pump, 15.3 per cent).

"The findings emphasize proof is needed to claim an intervention that reduces the of mild acute kidney injury better preserves long-term for the group that received it," the authors wrote. "This has implications for the development, testing, and use of interventions designed solely to prevent the degrees of acute kidney injury observed in CORONARY, and in determining acceptable adverse effects and costs of such interventions."

Explore further: Open heart surgery for kidney disease patients

More information: Garg AX, Devereaux PJ, Yusuf S, et al. "Kidney Function After Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial." JAMA. 2014;311(21):2191-2198. DOI: 10.1001/jama.2014.4952.

Related Stories

Open heart surgery for kidney disease patients

May 17, 2012
One type of open heart surgery is likely safer than the other for chronic kidney disease (CKD) patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Personalized fluid levels cuts acute kidney injury

May 28, 2014
(HealthDay)—A new fluid protocol is safe and effective in preventing contrast-induced acute kidney injury in patients undergoing cardiac catheterization, according to a study published in the May 24 issue of The Lancet.

Biomarkers of kidney injury indicate increased risk of death after discharge from cardiac surgery

December 20, 2013
Following cardiac surgery, patients with elevated levels of kidney injury biomarkers are at a significantly higher risk of dying during the next three years, a Yale study has found. The results appear in the Journal of the ...

BMC surgeon recommends off-pump coronary artery bypass grafting be abandoned

July 22, 2013
In a Special Report in the current issue of Circulation, Boston Medical Center cardiothoracic surgeon Harold Lazar, MD, has found that off-pump coronary artery bypass graft (OPCAB) surgery has failed to show any significant ...

Acute kidney injury may be a risk factor for later heart problems

February 6, 2014
Patients who experience abrupt kidney injury following surgery have an increased risk of later developing heart problems, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology ...

Risk of kidney disease doubled with use of fluoroquinolone antibiotics

June 3, 2013
The risk of acute kidney disease is doubled for people taking oral fluoroquinolone antibiotics, according to a study of published in CMAJ (Canadian Medical Association Journal).

Recommended for you

Creation of synthetic horsepox virus could lead to more effective smallpox vaccine

January 19, 2018
UAlberta researchers created a new synthetic virus that could lead to the development of a more effective vaccine against smallpox. The discovery demonstrates how techniques based on the use of synthetic DNA can be used to ...

Study ends debate over role of steroids in treating septic shock

January 19, 2018
The results from the largest ever study of septic shock could improve treatment for critically ill patients and save health systems worldwide hundreds of millions of dollars each year.

New approach could help curtail hospitalizations due to influenza infection

January 18, 2018
More than 700,000 Americans were hospitalized due to illnesses associated with the seasonal flu during the 2014-15 flu season, according to federal estimates. A radical new approach to vaccine development at UCLA may help ...

Zika virus damages placenta, which may explain malformed babies

January 18, 2018
Though the Zika virus is widely known for a recent outbreak that caused children to be born with microencephaly, or having a small head, and other malformations, scientists have struggled to explain how the virus affects ...

Certain flu virus mutations may compensate for fitness costs of other mutations

January 18, 2018
Seasonal flu viruses continually undergo mutations that help them evade the human immune system, but some of these mutations can reduce a virus's potency. According to new research published in PLOS Pathogens, certain mutations ...

Study reveals how MRSA infection compromises lymphatic function

January 17, 2018
Infections of the skin or other soft tissues with the hard-to-treat MRSA (methicillin-resistant Staphylococcus aureus) bacteria appear to permanently compromise the lymphatic system, which is crucial to immune system function. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.