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Effects of early high-dose erythropoietin on acute kidney injury following cardiac arrest: exploratory post hoc analyses from an open-label randomized trial.

ABSTRACT:

Background

Acute kidney injury (AKI) is frequent in patients resuscitated from cardiac arrest (CA) and may worsen outcome. Experimental data suggest a renoprotective effect by treating these patients with a high dose of erythropoietin (Epo) analogues. We aimed to evaluate the efficacy of epoetin alpha treatment on renal outcome after CA.

Methods

We did a post hoc analysis of the Epo-ACR-02 trial, which randomized patients with a persistent coma after a witnessed out-of-hospital CA. Only patients admitted in one intensive care unit were analysed. In the intervention group, patients received five intravenous injections of Epo spaced 12 h apart during the first 48 h, started as soon as possible after resuscitation. In the control group, patients received standard care without Epo. The main endpoint was the proportion of patients with persistent AKI defined by Kidney Disease: Improving Global Outcomes criteria at Day 2. Secondary endpoints included the occurrence of AKI through Day 7, estimated glomerular filtration rate (eGFR) at Day 28, haematological indices and adverse events.

Results

A total of 162 patients were included in the primary analysis (74 in the Epo group, 88 in the control group). Baseline characteristics were similar in the two groups. At Day 2, 52.8% of the patients (38/72) in the intervention group had an AKI, as compared with 54.4% of the patients (46/83) in the control group (P = 0.74). There was no significant difference between the two groups regarding the proportion of patients with AKI through Day 7. Among patients with persistent AKI at Day 2, 33% (4/12) in the intervention group had an eGFR <75 mL/min/1.73 m² compared with 25% (3/12) in the control group at Day 28 (P = 0.99). We found no significant differences in haematological indices or adverse events.

Conclusion

After CA, early administration of Epo did not confer any renal protective effect as compared with standard therapy.

SUBMITTER: Guillemet L

PROVIDER: S-EPMC7367106 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Effects of early high-dose erythropoietin on acute kidney injury following cardiac arrest: exploratory <i>post hoc</i> analyses from an open-label randomized trial.

Guillemet Lucie L Jamme Matthieu M Bougouin Wulfran W Geri Guillaume G Deye Nicolas N Vivien Benoît B Varenne Olivier O Pène Frédéric F Mira Jean-Paul JP Barat Florence F Treluyer Jean-Marc JM Hermine Olivier O Carli Pierre P Coste Joël J Cariou Alain A

Clinical kidney journal 20190617 3

<h4>Background</h4>Acute kidney injury (AKI) is frequent in patients resuscitated from cardiac arrest (CA) and may worsen outcome. Experimental data suggest a renoprotective effect by treating these patients with a high dose of erythropoietin (Epo) analogues. We aimed to evaluate the efficacy of epoetin alpha treatment on renal outcome after CA.<h4>Methods</h4>We did a <i>post hoc</i> analysis of the Epo-ACR-02 trial, which randomized patients with a persistent coma after a witnessed out-of-hosp ...[more]

PMID: 32699621

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