Erythropoietin and Protection of Renal function in Cardiac Surgery (EPRICS) trial

Introduction

To date, there are no known methods for preventing acute kidney injury after cardiac surgery. Increasing evidence suggests that erythropoietin (EPO) has renal anti-apoptotic and tissue protective effects [1], and in animal models a single high dose of EPO has been shown to ameliorate reperfusion injury after ischemia [2]. However, recent human studies have shown conflicting results. We aimed to study the effect of a single high dose of EPO preoperatively on renal function after coronary artery bypass grafting (CABG) in patients with preoperative impaired renal function.

Methods

This single-centre, randomized, double-blind, placebocontrolled study included 75 patients scheduled for CABG with preexisting renal impairment (estimated glomerular filtration rate based on p-cystatin C <60 ml/minute and >15 ml/minute). The patients either received a single high dose of EPO (400 lU/kg) or placebo preoperatively. The primary endpoint was renal protection evaluated by p-cystatin C at the third postoperative day compared with the preoperative values. Incidence of acute kidney injury and other renal biomarker changes were among secondary endpoints.

Results

There was no significant difference on the third postoperative day for p-cystatin C levels (2.1 ± 0.8 mg/l for the study group and 1.9 ± 0.5 mg/l for the control group, P = 0.51). There were no significant differences in other renal biomarkers or measures between the groups (p-NGAL, p-creatinine, p-urea, and estimated glomerular filtration rate). There were no other differences in outcome variables between the groups.

Conclusion

Intravenous administration of a single high dose (400 IU/ kg) of EPO did not have a renal protective effect in patients with reduced kidney function undergoing coronary artery bypass surgery.