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Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump : a randomized controlled trial

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Abstract
BACKGROUND: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. METHODS: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater (>= 26.5 mu mol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery. RESULTS: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease. INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery.
Keywords
HIGH-DOSE DEXAMETHASONE, STEROIDS, SIRS

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MLA
Garg, Amit X., et al. “Effect of Methylprednisolone on Acute Kidney Injury in Patients Undergoing Cardiac Surgery with a Cardiopulmonary Bypass Pump : A Randomized Controlled Trial.” CANADIAN MEDICAL ASSOCIATION JOURNAL, vol. 191, no. 9, 2019, pp. E247–56.
APA
Garg, A. X., Chan, M. T., Cuerden, M. S., Devereaux, P., Abbasi, S. H., Hildebrand, A., … Buggy, D. (2019). Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump : a randomized controlled trial. CANADIAN MEDICAL ASSOCIATION JOURNAL, 191(9), E247–E256.
Chicago author-date
Garg, Amit X, Matthew TV Chan, Meaghan S Cuerden, PJ Devereaux, Seyed Hesameddin Abbasi, Ainslie Hildebrand, Francois Lamontagne, et al. 2019. “Effect of Methylprednisolone on Acute Kidney Injury in Patients Undergoing Cardiac Surgery with a Cardiopulmonary Bypass Pump : A Randomized Controlled Trial.” CANADIAN MEDICAL ASSOCIATION JOURNAL 191 (9): E247–56.
Chicago author-date (all authors)
Garg, Amit X, Matthew TV Chan, Meaghan S Cuerden, PJ Devereaux, Seyed Hesameddin Abbasi, Ainslie Hildebrand, Francois Lamontagne, Andre Lamy, Nicolas Noiseux, Chirag R Parikh, Vlado Perkovic, Mackenzie Quantz, Antoine Rochon, Alistair Royse, Daniel I Sessler, Pallav J Shah, Jessica M Sontrop, Georgios I Tagarakis, Kevin H Teoh, Jessica Vincent, Michael Walsh, Jean-Pierre Yared, Salim Yusuf, Richard P Whitlock, R Whitlock, L Semelhago, V Chu, A Dyub, I Cybulsky, R Van Oosteen, G Cordova, MA Quantz, FN McKenzie, S Fox, L Chase, LM Stevens, I Prieto, F Basile, BA Finegan, C Bryden, S Meyer, A Chappell, CD Mazer, J Dixon, S Yagnik, C Crescini, S Verma, JF Legare, D Greentree, M Coutu, J Teijeira, W Wiley, C Peniston, C Teng, AG Rochon, Y Lamarche, A Deschamps, P Voisine, F Dagenais, RK Singal, CD Brown, TM Kieser, R Robinson, SE Fremes, GT Christakis, KN Melvin, M Parsons, H Zheng, J Yu, W Xu, Q Zhang, C Chen, H Yu, J Zeng, Y Zuo, J Liu, T Zhang, Y Sun, D Song, H Dong, M Chen, J Zhao, L Tao, W Huang, Y Cheng, YS Long, W Lei, W Zhang, MY Xu, E Qing, YB Xiao, J Karunakaran, VV Pillai, PB Reddy, S Kundan, AR Jain, SS Mallya, CB Mehta, V Shukla, K Kuruvila, G Karthikeyan, V Devagourou, MP Hote, B Airan, C Padmanabhan, M Srinivasan, SK Agarwal, S Pande, P Simha Mohan Rao, R Math, BPR Shankar, PH Vaijyanath, SK Nair, DR Ayapati, A Kurz, A Awais, K Panjasawatwong, BK Kashy, JL Huffmyer, DC Scalzo, A Kazemi, KF Huang, SV Parvathaneni, JC Gardner, MR Malik, Y Eshraghi, RS Kramer, MK Essandoh, J Portillo, SS Ayad, Z Akhtar, MR Castresana, CD Collard, YF Rodriguez-Blanco, MP Eaton, JC Villar, JP Umana, CL Dominguez, PA Alvarado, D Zuluaga, M Abello, T Sarquis, E Vaquiro, CA Oliveros, EJ Manrique, S Vasquez, LM Ortiz, J Holliday, R Griffin, AG Royse, CF Royse, Z Williams, D Paparella, C Rotunno, M De Palo, V Margari, O Alfieri, D Ferrara, D Schiavi, A Parolari, VA Myasoedova, A Daprati, M De Feo, C Bancone, R Di Bartolomeo, D Pacini, M Ribezzo, A. Karimi, A Salehiomran, A Hajighasemi, P Bina, Z Straka, J Hlavicka, P Lukac, K Vik, F Mosna, NB Tsilimingas, VN Simopoulos, F Tsolaki, MT Rivilla, J Galan, JAF Nunez, A Gonzalez, D Ruiz, M Orts Rodriguez, M Issa, DC Vila Nova, LN Maia, MA Nakazone, GV Lico e Cividanes, LA Hajjar, V Avila Neto, FA Lucchese, NA Stolf, D Hutschala, K Ruetzler, B Sima, S Engelen, S Borms, M Van de Velde, S Rex, Stefan De Hert, AMH Ho, MTV Chan, MJ Underwood, D Deluca Bisurgi, D Torres, and DJ Buggy. 2019. “Effect of Methylprednisolone on Acute Kidney Injury in Patients Undergoing Cardiac Surgery with a Cardiopulmonary Bypass Pump : A Randomized Controlled Trial.” CANADIAN MEDICAL ASSOCIATION JOURNAL 191 (9): E247–E256.
Vancouver
1.
Garg AX, Chan MT, Cuerden MS, Devereaux P, Abbasi SH, Hildebrand A, et al. Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump : a randomized controlled trial. CANADIAN MEDICAL ASSOCIATION JOURNAL. 2019;191(9):E247–56.
IEEE
[1]
A. X. Garg et al., “Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump : a randomized controlled trial,” CANADIAN MEDICAL ASSOCIATION JOURNAL, vol. 191, no. 9, pp. E247–E256, 2019.
@article{8621637,
  abstract     = {BACKGROUND: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. 
METHODS: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater (>= 26.5 mu mol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery. 
RESULTS: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease. 
INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery.},
  author       = {Garg, Amit X and Chan, Matthew TV and Cuerden, Meaghan S and Devereaux, PJ and Abbasi, Seyed Hesameddin and Hildebrand, Ainslie and Lamontagne, Francois and Lamy, Andre and Noiseux, Nicolas and Parikh, Chirag R and Perkovic, Vlado and Quantz, Mackenzie and Rochon, Antoine and Royse, Alistair and Sessler, Daniel I and Shah, Pallav J and Sontrop, Jessica M and Tagarakis, Georgios I and Teoh, Kevin H and Vincent, Jessica and Walsh, Michael and Yared, Jean-Pierre and Yusuf, Salim and Whitlock, Richard P and Whitlock, R and Semelhago, L and Chu, V and Dyub, A and Cybulsky, I and Van Oosteen, R and Cordova, G and Quantz, MA and McKenzie, FN and Fox, S and Chase, L and Stevens, LM and Prieto, I and Basile, F and Finegan, BA and Bryden, C and Meyer, S and Chappell, A and Mazer, CD and Dixon, J and Yagnik, S and Crescini, C and Verma, S and Legare, JF and Greentree, D and Coutu, M and Teijeira, J and Wiley, W and Peniston, C and Teng, C and Rochon, AG and Lamarche, Y and Deschamps, A and Voisine, P and Dagenais, F and Singal, RK and Brown, CD and Kieser, TM and Robinson, R and Fremes, SE and Christakis, GT and Melvin, KN and Parsons, M and Zheng, H and Yu, J and Xu, W and Zhang, Q and Chen, C and Yu, H and Zeng, J and Zuo, Y and Liu, J and Zhang, T and Sun, Y and Song, D and Dong, H and Chen, M and Zhao, J and Tao, L and Huang, W and Cheng, Y and Long, YS and Lei, W and Zhang, W and Xu, MY and Qing, E and Xiao, YB and Karunakaran, J and Pillai, VV and Reddy, PB and Kundan, S and Jain, AR and Mallya, SS and Mehta, CB and Shukla, V and Kuruvila, K and Karthikeyan, G and Devagourou, V and Hote, MP and Airan, B and Padmanabhan, C and Srinivasan, M and Agarwal, SK and Pande, S and Rao, P Simha Mohan and Math, R and Shankar, BPR and Vaijyanath, PH and Nair, SK and Ayapati, DR and Kurz, A and Awais, A and Panjasawatwong, K and Kashy, BK and Huffmyer, JL and Scalzo, DC and Kazemi, A and Huang, KF and Parvathaneni, SV and Gardner, JC and Malik, MR and Eshraghi, Y and Kramer, RS and Essandoh, MK and Portillo, J and Ayad, SS and Akhtar, Z and Castresana, MR and Collard, CD and Rodriguez-Blanco, YF and Eaton, MP and Villar, JC and Umana, JP and Dominguez, CL and Alvarado, PA and Zuluaga, D and Abello, M and Sarquis, T and Vaquiro, E and Oliveros, CA and Manrique, EJ and Vasquez, S and Ortiz, LM and Holliday, J and Griffin, R and Royse, AG and Royse, CF and Williams, Z and Paparella, D and Rotunno, C and De Palo, M and Margari, V and Alfieri, O and Ferrara, D and Schiavi, D and Parolari, A and Myasoedova, VA and Daprati, A and De Feo, M and Bancone, C and Di Bartolomeo, R and Pacini, D and Ribezzo, M and Karimi, A. and Salehiomran, A and Hajighasemi, A and Bina, P and Straka, Z and Hlavicka, J and Lukac, P and Vik, K and Mosna, F and Tsilimingas, NB and Simopoulos, VN and Tsolaki, F and Rivilla, MT and Galan, J and Nunez, JAF and Gonzalez, A and Ruiz, D and Orts Rodriguez, M and Issa, M and Vila Nova, DC and Maia, LN and Nakazone, MA and Lico e Cividanes, GV and Hajjar, LA and Neto, V Avila and Lucchese, FA and Stolf, NA and Hutschala, D and Ruetzler, K and Sima, B and Engelen, S and Borms, S and Van de Velde, M and Rex, S and De Hert, Stefan and Ho, AMH and Chan, MTV and Underwood, MJ and Deluca Bisurgi, D and Torres, D and Buggy, DJ},
  issn         = {0820-3946},
  journal      = {CANADIAN MEDICAL ASSOCIATION JOURNAL},
  keywords     = {HIGH-DOSE DEXAMETHASONE,STEROIDS,SIRS},
  language     = {eng},
  number       = {9},
  pages        = {E247--E256},
  title        = {Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump : a randomized controlled trial},
  url          = {http://dx.doi.org/10.1503/cmaj.181644},
  volume       = {191},
  year         = {2019},
}

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