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Significance Statement
Safely reducing red blood cell transfusions could prevent transfusion-related adverse effects. Both anemia and transfusion may harm the kidney, but how reducing transfusions might affect AKI risk is unknown. To investigate this issue, the authors conducted a prespecified kidney substudy of a multinational, randomized noninferiority trial of 4531 patients undergoing cardiac surgery with cardiopulmonary bypass. Patients were randomized to a restrictive approach for receiving red blood cell transfusion (transfuse if hemoglobin<7.5 g/dl) or a more liberal approach (transfuse if hemoglobin<9.5 g/dl). Patients in the restrictive group received 38% fewer transfusions than patients in the liberal group (1.8 versus 2.9 transfusions, on average, respectively), and both approaches were equally safe with respect to AKI risk. Results were similar in patients with preoperative CKD.
Abstract
Background Safely reducing red blood cell transfusions can prevent transfusion-related adverse effects, conserve the blood supply, and reduce health care costs. Both anemia and red blood cell transfusion are independently associated with AKI, but observational data are insufficient to determine whether a restrictive approach to transfusion can be used without increasing AKI risk.