Aspirin or blood pressure medication before and after surgery does not reduce risk of AKI

November 15, 2014, The JAMA Network Journals

In patients undergoing noncardiac surgery, neither aspirin nor clonidine (a medication primarily used to treat high blood pressure) taken before and after surgery reduced the risk of acute kidney injury, according to a study appearing in JAMA. The study is being released to coincide with its presentation at the American Society of Nephrology's annual Kidney Week meeting.

About 10 percent of the 200 million adults estimated to undergo major each year develop (a sudden loss of kidney function). Perioperative (around the time of surgery) acute is associated with poor outcomes, a long hospital stay, and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however these effects are uncertain and each intervention has the potential for harm (bleeding with aspirin and abnormally low with clonidine), which could increase the risk of acute kidney injury, according to background information in the article.

Amit X. Garg, M.D., Ph.D., of the London Health Sciences Centre and Western University, London, Ontario, Canada, and colleagues randomly assigned 6,905 patients undergoing noncardiac surgery from 88 centers in 22 countries to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days after surgery; oral clonidine (0.2 mg) or placebo 2 to 4 hours before surgery, and then a transdermal clonidine patch (applied to the skin) or placebo patch that remained until 72 hours after . Acute kidney injury was primarily defined as a certain increase in serum creatinine concentration (a substance commonly found in blood, urine, and muscle tissue and used as an indicator of ).

The researchers found that neither aspirin nor clonidine reduced the risk of acute kidney injury. The percentage of patients in each study group who experienced acute kidney injury: aspirin 13.4 percent vs 12.3 percent (placebo); clonidine 13.0 percent vs 12.7 percent (placebo).

Aspirin increased the risk of major bleeding. In turn, major bleeding was associated with a greater risk of subsequent acute kidney injury (23.3 percent when bleeding was present vs 12.3 percent when bleeding was absent). Similarly, clonidine increased the risk of clinically important hypotension (abnormally ). Such hypotension was associated with a greater risk of subsequent acute kidney injury (14.3 percent when hypotension was present vs 11.8 percent when hypotension was absent).

The authors write that future large trials to prevent acute kidney injury in the surgical setting should focus on interventions that target pathways other than inhibiting platelet aggregation and alpha 2-adrenergic agonism. "Interventions that prevent perioperative bleeding and perioperative hypotension may prove useful."

Explore further: Drug for kidney injury after cardiac surgery does not reduce need for dialysis

More information: DOI: 10.1001/jama.2014.15284

Related Stories

Drug for kidney injury after cardiac surgery does not reduce need for dialysis

September 29, 2014
Among patients with acute kidney injury after cardiac surgery, infusion with the antihypertensive agent fenoldopam, compared with placebo, did not reduce the need for renal replacement therapy (dialysis) or risk of death ...

Clonidine doesn't reduce deaths or heart attack after non-cardiac surgery

March 31, 2014
Clonidine – a drug that reduces blood pressure and heart rate – increased rates of clinically concerning hypotension and non-fatal cardiac arrest after noncardiac surgery, according to the POISE-2 trial presented at the ...

NephroCheck test approved to predict kidney injury risk

September 5, 2014
(HealthDay)—The NephroCheck test, designed to predict the risk of sudden kidney injury within 12 hours, has been approved by the U.S. Food and Drug Administration.

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

June 4, 2014
(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 ...

Major bleeds rise with perioperative aspirin for non-cardiac surgery

March 31, 2014
Patients given aspirin to prevent heart problems after non-heart-related surgery had a higher risk of serious bleeding than the patients who did not receive aspirin. At the same time, aspirin did not reduce incidence of post-operative ...

Use of calcium-channel blocker and antibiotic associated with small increased risk of kidney injury

November 9, 2013
Among older adults taking a calcium-channel blocker, simultaneous use of the antibiotic clarithromycin, compared with azithromycin, was associated with a small but statistically significant greater 30-day risk of hospitalization ...

Recommended for you

Research finds new mechanism that can cause the spread of deadly infection

April 20, 2018
Scientists at the University of Birmingham have discovered a unique mechanism that drives the spread of a deadly infection.

Selection of a pyrethroid metabolic enzyme CYP9K1 by malaria control activities

April 20, 2018
Researchers from LSTM, with partners from a number of international institutions, have shown the rapid selection of a novel P450 enzyme leading to insecticide resistance in a major malaria vector.

Study predicts 2018 flu vaccine will have 20 percent efficacy

April 19, 2018
A Rice University study predicts that this fall's flu vaccine—a new H3N2 formulation for the first time since 2015—will likely have the same reduced efficacy against the dominant circulating strain of influenza A as the ...

Low-cost anti-hookworm drug boosts female farmers' physical fitness

April 19, 2018
Impoverished female farm workers infected with intestinal parasites known as hookworms saw significant improvements in physical fitness when they were treated with a low-cost deworming drug. The benefits were seen even in ...

Zika presents hot spots in brains of chicken embryos

April 19, 2018
Zika prefers certain "hot spots" in the brains of chicken embryos, offering insight into how brain development is affected by the virus.

Super-superbug clones invade Gulf States

April 18, 2018
A new wave of highly antibiotic resistant superbugs has been found in the Middle East Gulf States, discovered by University of Queensland researchers.

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.