May 20, 2015
Low-Cost Anti-inflammatory Drug Reduces Severe AKI
After Cardiac Surgery

Utrecht, The Netherlands—Patients who received the anti-inflammatory drug dexamethasone during heart surgery had about 2.5-times lower risk of developing kidney failure requiring dialysis compared with those receiving a placebo, according to a new Dutch study.

Results of the randomized clinical trial, which were published recently in the Journal of the American Society of Nephrology as a brief communication, found the greatest benefits for patients with pre-existing advanced chronic kidney disease.

The authors from University Medical Center, Utrecht, The Netherlands suggest that their findings could change patient care during cardiac surgical procedures.

The article notes that about 1% of patients undergoing cardiac surgery develop severe acute kidney injury (AKI) that arises after surgery and requires dialysis; the incidence is even higher among patients with preoperative chronic kidney disease. Those patients experience death rates of more than 40% while in the hospital, according to the study.

“One percent sounds like a small percentage, however given the fact that each year, over half a million people undergo heart surgery in the United States alone, this means that an estimated 5,000 patients develop renal failure and of those about 2,500 die as a result of this complication,” said lead author Kirolos Jacob, MD.

Noting that heart surgery initiates an inflammatory reaction in the body that can have negative effects on the kidneys, the research team sought to determine if giving patients dexamethasone could decrease the risk of severe AKI following cardiac surgery.

Researchers analyzed the results of a large randomized controlled trial called the Dutch Dexamethasone for Cardiac Surgery (DECS) trial, which included 4,465 patients undergoing cardiac surgery who were randomized to receive placebo or dexamethasone during surgery. The original trial tested whether dexamethasone could reduce the risk of a variety of major postoperative complications, but, in this analysis, the focus was solely on kidney failure and its most severe form, AKI, requiring dialysis.

According to the results, severe AKI requiring dialysis occurred in 10 patients (0.4%) in the dexamethasone group compared to 23 patients (1.0%) in the placebo group.

“The beneficial effects of dexamethasone were particularly present in those who already had pre-existing kidney disease before heart surgery,” Jacob said. “This reinforces the fact that this drug could be of major importance for the increasing elderly population with pre-existing kidney disease undergoing a heart operation.”

He added that a single dose of dexamethasone during a heart operation is inexpensive, straightforward, painless, and safe for patients, pointing out, “These advantages make the intervention very accessible and cost-effective, especially since the costs for dialysis are very high.”

U.S. Pharmacist Social Connect