• Kirolos A Jacob, David E Leaf, Jan M Dieleman, Diederik van Dijk, Arno P Nierich, Peter M Rosseel, Joost M van der Maaten, Jan Hofland, Jan C Diephuis, Fellery de Lange, Christine Boer, Jolanda Kluin, Sushrut S Waikar, and Dexamethasone for Cardiac Surgery (DECS) Study Group.
• Departments of Anesthesiology and Intensive Care Medicine and Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; k.a.jacob@umcutrecht.nl.
• J. Am. Soc. Nephrol. 2015 Dec 1; 26 (12): 2947-51.

AbstractAdministration of prophylactic glucocorticoids has been suggested as a strategy to reduce postoperative AKI and other adverse events after cardiac surgery requiring cardiopulmonary bypass. In this post hoc analysis of a large placebo-controlled randomized trial of dexamethasone in 4465 adult patients undergoing cardiac surgery, we examined severe AKI, defined as use of RRT, as a primary outcome. Secondary outcomes were doubling of serum creatinine level or AKI-RRT, as well as AKI-RRT or in-hospital mortality (RRT/death). The primary outcome occurred in ten patients (0.4%) in the dexamethasone group and in 23 patients (1.0%) in the placebo group (relative risk, 0.44; 95% confidence interval, 0.19 to 0.96). In stratified analyses, the strongest signal for potential benefit of dexamethasone was in patients with an eGFR<15 ml/min per 1.73 m(2). In conclusion, compared with placebo, intraoperative dexamethasone appeared to reduce the incidence of severe AKI after cardiac surgery in those with advanced CKD.Copyright © 2015 by the American Society of Nephrology.

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