Abstract: FR-OR147
Effect of a Restrictive Versus Liberal Approach to Red Blood Cell Transfusion on AKI in Patients Undergoing Cardiac Surgery
Session Information
- High-Impact Clinical Trials
October 26, 2018 | Location: 20A, San Diego Convention Center
Abstract Time: 11:45 AM - 12:00 PM
Category: Acute Kidney Injury
- No subcategory defined
Authors
- Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
- Mazer, C. David, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Group or Team Name
- TRICS Investigators
Background
Safely reducing red blood cell transfusions avoids transfusion-related adverse effects, conserves the blood supply, and reduces healthcare costs. We conducted a prespecified substudy of the Transfusion Requirements in Cardiac Surgery-III (TRICS-III) trial to determine if a restrictive approach to red blood cell transfusion is as safe as a liberal approach on the risk of acute kidney injury [protocol Can J Kid Health Dis 2018 Jan 3; 5].
Methods
This was a randomized trial of 4531 moderate-to-high–risk patients undergoing cardiac surgery with cardiopulmonary bypass from 73 centers in 19 countries between January 2014 and March 2017. Patients were assigned to a restrictive red blood cell transfusion threshold (transfuse if hemoglobin level was <7.5 g/dL, intraoperatively and postoperatively until day 28 or hospital discharge; n=2251) or a liberal threshold (transfuse if hemoglobin level was <9.5 g/dL in the operating room or intensive care unit, or <8.5 g/dL on the non-intensive care ward; n=2280). Acute kidney injury was defined as an increase in the postoperative serum creatinine concentration (from the preoperative value) of >0.3 mg/dL (≥26.5 μmol/L) within 48 hrs of surgery, or >50% within 7 days of surgery. The prespecified noninferiority margin for the absolute risk difference was 3.5%.
Results
Perioperative acute kidney injury occurred in 27.7% of patients in the restrictive-threshold group and in 27.9% of patients in the liberal-threshold group; absolute risk difference, -0.2% (95% CI, -2.8% to 2.4%). Results were consistent with multiple alternative definitions of acute kidney injury, and in the subgroup with preoperative chronic kidney disease (Table).
Conclusion
A restrictive approach to red blood cell transfusion was as safe as a liberal approach on the risk of acute kidney injury in patients undergoing cardiac surgery. Trial Registration: NCT02042898
| Number of Events (%) | |||
| Restrictive (n=2251) | Liberal (n=2280) | Risk difference (95% CI) | |
| AKI (primary outcome) | 624 (27.7%) | 636 (27.9%) | -0.2% (-2.8% to 2.4%) |
| Alternative Definitions | |||
| AKI or death | 636 (28.3%) | 662 (29.0%) | -0.8% (-3.4% to 1.9%) |
| ≥ Stage 2 AKI | 166 (7.4%) | 150 (6.6%) | 0.8% (-0.7% to 2.3%) |
| Stage 3 AKI | 75 (3.3%) | 84 (3.7%) | -0.4% (-1.4% to 0.7%) |
| Acute dialysis | 54 (2.4%) | 66 (2.9%) | -0.5% (-1.4% to 0.4%) |
| Subgroup | |||
| Chronic Kidney Disease | 258/767 (33.6%) | 252/755 (32.5%) | 1.1% (-3.6% to 5.8%) |
AKI=Acute Kidney Injury
Funding
- Government Support - Non-U.S.