J Korean Med Sci.  2012 May;27(5):506-511. 10.3346/jkms.2012.27.5.506.

Erythropoietin Improves Long-Term Outcomes in Patients with Acute Kidney Injury after Coronary Artery Bypass Grafting

• Oh SW
• Chin HJ
• Chae DW
• Na KY

• KMID: 1372792
• DOI: http://doi.org/10.3346/jkms.2012.27.5.506

Abstract

Previous studies reported the beneficial effect of erythropoietin (EPO) in acute injuries. We followed patients with and without acute kidney injury (AKI) after coronary artery bypass grafting (CABG) and evaluated the effect of EPO on long-term outcome. We also assessed the efficacy of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a predictive marker of AKI. Seventy-one patients scheduled for elective CABG were randomly given either 300 U/kg of EPO or saline before CABG. The primary outcome was AKI, and the secondary outcome was the all-cause-mortality and composite of all-cause-mortality and end stage renal disease (ESRD). Twenty-one patients had AKI, 14 (66.7%) in the placebo group and 7 (33.3%) in the EPO group (P = 0.05). Also, uNGAL was higher in the patients with AKI than in those without AKI at baseline, 2, 4, 24, and 72 hr after CABG (P = 0.011). Among patients with AKI, 2-week creatinine (Cr) was not different from baseline Cr in the EPO group, but 2-week Cr was significantly higher than baseline Cr in the placebo group (P = 0.009). All-cause-mortality (P = 0.022) and the composite of all-cause-mortality and ESRD (P = 0.003) were reduced by EPO. EPO reduces all-cause-mortality and ESRD in patients with AKI, largely due to the beneficial effect of EPO on recovery after AKI.

Keyword

Erythropoietin; Neutrophil Gelatinase-Associated Lipocalin Protein; Mortality

MeSH Terms

Acute Kidney Injury/etiology/mortality/*prevention & control
Acute-Phase Proteins/urine
Aged
Aged, 80 and over
Biological Markers/urine
Coronary Artery Bypass/*adverse effects
Creatinine/analysis
Double-Blind Method
Erythropoietin/*therapeutic use
Female
Hematinics/*therapeutic use
Humans
Kaplan-Meier Estimate
Lipocalins/urine
Male
Middle Aged
Placebo Effect
Prospective Studies
Proto-Oncogene Proteins/urine
ROC Curve
Recombinant Proteins/therapeutic use
Risk Factors
Treatment Outcome

Figure

• 

  Fig. 1 Changes of serum creatinine after coronary artery bypass grafting in patients with AKI. *P < 0.05 vs 0 days, both EPO and placebo group; †P < 0.05 vs 0 days, placebo group only. Error bars show the standard deviation of mean.

• 

  Fig. 2 Kaplan-Meier curves for composite outcome of mortality or ESRD. Participants were classified according to the development of AKI and the administration of EPO: group A, AKI in EPO group; group B, no AKI in placebo group; group C, no AKI in EPO group; group D, AKI in placebo group.

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