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El impacto de la hemoadsorción en pacientes con enfermedad renal crónica sometidos a injerto de derivación arterial
Erdal Simsek1, Serdar Gunaydin1
1Department of Cardiovascular Surgery, University of Health Sciences, Ankara City Hospital Campus, Ankara, Turkey.
Clinical kidney journal
|September 4, 2025
Resumen
La hemoadsorción intraoperatoria (HA) redujo la lesión renal y la inflamación en pacientes con cirugía cardíaca con enfermedad renal crónica leve. Esta estrategia de protección renal redujo la necesidad de terapia de reemplazo renal y acortó las estadías en UCI.
Área de la Ciencia:
- Nefrología
- Cardiología
- Medicina de cuidados intensivos
- Terapia de reemplazo renal
Sus antecedentes:
- La lesión renal aguda asociada a la cirugía cardíaca (CSA-AKI) es una complicación común con una morbilidad significativa.
- Las estrategias de protección renal son cruciales para los pacientes sometidos a un injerto de derivación de la arteria coronaria (CABG).
- Los pacientes con enfermedad renal crónica límite (KDIGO G2/ A2) tienen un mayor riesgo.
Objetivo del estudio:
- Evaluar el impacto de la hemoadsorción intraoperatoria (HA) en los resultados clínicos en pacientes con KDIGO G2/A2 sometidos a CABG.
- Evaluar el efecto del HA en la función renal, los marcadores inflamatorios y la utilización de los recursos.
Principales métodos:
- Un estudio de emparejamiento de propensión comparó a 40 pacientes que recibieron HA intraoperatorio durante CABG (grupo HA) con 40 controles.
- Los parámetros de valoración primarios incluyeron la necesidad de terapia de reemplazo renal (TRR) y el empeoramiento de la etapa KDIGO.
- Los puntos finales secundarios evaluados fueron los biomarcadores inflamatorios, el uso de vasopresores y la estadía en UCI/hospital.
Principales resultados:
- El grupo de HA mostró un empeoramiento significativamente menor en la etapa de KDIGO (P=0,04), un uso reducido de RRT (P=0,02) y estancias más cortas en UCI (P=0,03).
- Los niveles postoperatorios de creatinina sérica, mioglobina, NT-proBNP, IL-6, procalcitonina, proteína C reactiva y D-dimero fueron significativamente más bajos en el grupo de HA.
- No se observaron diferencias demográficas significativas entre los grupos.
Conclusiones:
- La hemoadsorción intraoperatoria demuestra beneficios potenciales en la preservación de la función renal y en la reducción de la inflamación en pacientes con CABG con ERC leve.
- El tratamiento con HA puede mitigar la CSA-AKI y las complicaciones asociadas.
- Se requiere una mayor validación en ensayos multicéntricos de gran tamaño.
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