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Acute kidney injury after cardiac surgery: is minocycline protective?
Ladan Golestaneh1, Kathryn Lindsey, Pooja Malhotra
1Montefiore Medical Center, Albert Einstein Medical Center, 3411 Wayne Ave, Suite 5H, Bronx, NY, 10467, USA, lgolesta@montefiore.org.
Background And Objectives:
Acute kidney injury (AKI) after cardiac bypass surgery (CABG) is common and carries a significant association with morbidity and mortality. Since minocycline therapy attenuates kidney injury in animal models of AKI, we tested its effects in patients undergoing CABG.
Design, Setting, Participants And Measurements:
This is a randomized, double-blinded, placebo-controlled, multi-center study. We screened high risk patients who were scheduled to undergo CABG in two medical centers between Jan 2008 and June 2011. 40 patients were randomized and 19 patients in each group completed the study. Minocycline prophylaxis was given twice daily, at least for four doses prior to CABG. Primary outcome was defined as AKI [0.3 mg/dl increase in creatinine (Cr)] within 5 days after surgery. Daily serum Cr for 5 days, various clinical and hemodynamic measures and length of stay were recorded.
Results:
The two groups had similar baseline and intra-operative characteristics. The primary outcome occurred in 52.6% of patients in the minocycline group as compared to 36.8% of patients in the placebo group (p = 0.51). Peak Cr was 1.6 ± 0.7 vs. 1.5 ± 0.7 mg/dl (p = 0.45) in minocycline and placebo groups, respectively. Death at 30 days occurred in 0 vs. 10.5% in the minocycline and placebo groups, respectively (p = 0.48). There were no differences in post-operative length of stay, and cardiovascular events between the two groups. There was a trend towards lower diastolic pulmonary artery pressure [16.8 ± 4.7 vs. 20.7 ± 6.6 mmHg (p = 0.059)] and central venous pressure [11.8 ± 4.3 vs. 14.6 ± 5.6 mmHg (p = 0.13)] in the minocycline group compared to placebo on the first day after surgery.
Conclusions:
Minocycline did not protect against AKI post-CABG.
Insights
Minocycline did not prevent acute kidney injury (AKI) after cardiac bypass surgery (CABG). This study found no significant difference in AKI rates between minocycline and placebo groups in high-risk patients.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Acute kidney injury (AKI) is a frequent complication following cardiac bypass surgery (CABG), associated with increased morbidity and mortality.
- Minocycline has demonstrated renoprotective effects in animal models of AKI.
Purpose of the Study:
- To evaluate the efficacy of minocycline in preventing AKI in patients undergoing CABG.
Main Methods:
- A randomized, double-blinded, placebo-controlled, multi-center study.
- High-risk patients scheduled for CABG received either minocycline or placebo.
- Primary outcome: AKI (defined as a 0.3 mg/dl increase in serum creatinine) within 5 days post-surgery.
Main Results:
- The incidence of AKI was 52.6% in the minocycline group versus 36.8% in the placebo group (p=0.51).
- No significant differences were observed in peak serum creatinine, 30-day mortality, length of stay, or cardiovascular events.
- A trend towards lower diastolic pulmonary artery pressure and central venous pressure was noted in the minocycline group on postoperative day 1.
Conclusions:
- Minocycline prophylaxis did not demonstrate a protective effect against AKI in patients undergoing CABG.
- Further research may be needed to explore potential benefits in specific patient subgroups or alternative therapeutic strategies.
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