From: Erythropoiesis stimulating agents and reno-protection: a meta-analysis
Reference | Study Location | Patient Population | ESA | Control | Subjects (Total and # in groups) | Renal Injury (AKI) Definition | Other Outcomes |
---|---|---|---|---|---|---|---|
Dardashti 2014 [24] | Sweden (Skåne University Hospital, Lund) | Patients scheduled for CABG with preexisting renal impairment | Epoetin zeta (400 IU/kg; Retacrit®) administered preoperative | Equivalent volume of saline | N = 70: ESA(35), control(35) | RIFLE on d3 based on eGFR using the Modification of Diet in Renal Disease formula | No difference in Hb, transfusions, relative cystatin C, NGAL, creatinine, urea, or eGFR) |
deSeigneux 2012 [76] | Switzerland (University Hospital, Geneva) | Patients admitted to the ICU for cardiac surgery | ESA Group 1 (20,000 IU; epoetin α), group 2 (40,000 UI epoetin α) & group 3 (control) 1 to 4 h post-surgery | Isotonic sodium chloride | N = 80: ESA group 1(20), ESA group 2(20), control(40) | AKIN from ICU admission to the following wk | No difference in Hb, creatinine, cystatin c, or urinary NGAL levels |
Endre 2010 [26] | New Zealand (Christchurch or Dunedin Hospital) | Patients admitted to the ICU or high-risk patients scheduled for cardiothoracic surgery with CPB | ESA (500 U/kg (iv) to a maximum of 50,000 U), within 6 h of increased GGT AP and a second dose 2 h later | Equivalent volume of normal saline | N = 163: ESA(84), control(78) | AKIN classification in 7 days | No difference in any creatinine-based variables |
Kim 2013 [27] | Korea (Yonsei University Health System, Seoul) | Patients with preoperative risk factors for AKI who were scheduled for complex valvular heart operations | Epoetin α (300 IU/kg (iv); Epocain) after anesthetic induction | Equivalent volume of normal saline. | N = 98: ESA(49), control(49) | An increase in serum creatinine >0.3 mg/dl or >50% from baseline: | No differences in Hb, sCr, eGFR, creatinine clearance, cystatin C or serum NGAL |
Olweny 2012 [21] | USA (UT Southwestern, Houston, Texas) | Patients who underwent laparoscopic partial nephrectomy | Epoetin α (500 IU/kg (iv) Procrit) 30 min prior to LPN | No ESA | N = 106: ESA(52), control(54). | NA | No difference in eGFR |
Oh 2012 [16] | Korea, National University Bundang Hospital, Seoul | Patients scheduled for elective CABG | Epoetin β (300 U/kg Recormon) before CABG | Saline | N = 71: ESA(36,) control(35). | SCr ≥ 0.3 mg/dL from baseline, ≥50% increase in the sCr concentration in the first 72 h after CABG, or <0.5 mL/kg per hour of oliguria for more than six hr | sCr was not different from baseline in the ESA group, but was higher in the placebo group. |
Park 2005 [20] | USA (surgical ICU), cardiothoracic ICU, or medical ICU at Barnes-Jewish Hospital, St Louis, Missouri) | Patients scheduled for elective CABG | ESA (112 U/kg/week average) within the first 14 days of RRT initiation | No ESA | N = 187; ESA(71), control(116) | NA | No difference in transfusions. sCr at 2 weeks favored the ESA arm but did not reach statistical significance (p = 0.054). No difference in renal recovery or renal survival |
Tasanarong 2013 [28] | Thailand (Thammasat Chalerm Prakiat Hospital) | Patients scheduled for elective CABG using CPB | epoetin β (200 U/kg; Recormon) 3 d before CABG and 100 U/kg at the operation time. | Same volume & schedule of 0.9% saline | N = 100: ESA(50), control(50) | ≥0.3 mg/dl or ≥50% increase in sCr from baseline within the first 48 h post-operation according to the KDIGO 2012 criteria. | No difference in Hb. sCr increase and eGFR decrease was lower in the ESA group. Mean urine NGAL group was lower in the ESA group 2 h & 18 h. |
Yoo 2011 [29] | Korea (Yonsei University Health System, Seoul) | Patients scheduled for valvular heart surgery (VHS) with preoperative anemia | Epoetin α (500 IU/kg (iv); Epocain and 200 mg iron sucrose (iv)) 16-24 h pre-surgery | Equivalent volume of normal saline | N = 74: ESA(37), control(37) | Increased sCr of 0.3 mg/dl, or 50–200% from baseline, using modified RIFLE classification within 48 h after surgery | Reduced transfusions. No difference in mortality |