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The association of epsilon-aminocaproic acid with postoperative decrease in creatinine clearance in 1502 coronary
M Stafford-Smith1, B Phillips-Bute, D N Reddan
1Departments of Anesthesiology and Medicine (Division of Nephrology), Duke University Medical Center, Durham, North Carolina 27710, USA. staff002@mc.duke.edu
Anesthesia and Analgesia
|October 26, 2000
Summary
Epsilon-aminocaproic acid (EACA) administration during cardiac surgery did not reduce creatinine clearance in patients, including those with pre-existing renal disease. This study suggests EACA is safe for kidney function post-heart surgery.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Renal dysfunction is a significant complication following cardiac surgery.
- Epsilon-aminocaproic acid (EACA) use has raised concerns regarding renal safety due to unreliable markers like proteinuria and hyperkalemia.
- Change in creatinine clearance (DCrCl) offers a more reliable measure of renal function post-cardiac surgery.
Purpose of the Study:
- To investigate the association between EACA administration and perioperative changes in creatinine clearance after heart surgery.
- To specifically assess the impact of EACA on patients with pre-existing renal disease undergoing coronary artery bypass graft (CABG) surgery.
Main Methods:
- A retrospective analysis of elective primary coronary artery bypass graft patients between July 1991 and December 1992.
- Calculation of DCrCl using preoperative and postoperative peak serum creatinine values via the Cockroft-Gault equation.
- Separate analysis of a subgroup with preoperative creatinine levels > or = 133 micromol/L.
Main Results:
- Multivariate analyses identified known risk factors for renal dysfunction but found no significant association between EACA and reduced creatinine clearance in the overall patient group (P = 0.66).
- No significant association between EACA and reduced creatinine clearance was observed in the subgroup of patients with preoperative renal impairment (P = 0.42).
Conclusions:
- EACA administration at moderate doses during primary CABG surgery was not associated with postoperative reductions in creatinine clearance, even in patients with preoperative renal dysfunction.
- This retrospective study suggests EACA is safe for renal function in this context, but further prospective studies using diverse renal function tests are warranted for confirmation.