Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

J Am Soc Nephrol. 2015 Dec;26(12):2947-51. doi: 10.1681/ASN.2014080840. Epub 2015 May 7.


Administration of prophylactic glucocorticoids has been suggested as a strategy to reduce postoperative AKI and other adverse events after cardiac surgery requiring cardiopulmonary bypass. In this post hoc analysis of a large placebo-controlled randomized trial of dexamethasone in 4465 adult patients undergoing cardiac surgery, we examined severe AKI, defined as use of RRT, as a primary outcome. Secondary outcomes were doubling of serum creatinine level or AKI-RRT, as well as AKI-RRT or in-hospital mortality (RRT/death). The primary outcome occurred in ten patients (0.4%) in the dexamethasone group and in 23 patients (1.0%) in the placebo group (relative risk, 0.44; 95% confidence interval, 0.19 to 0.96). In stratified analyses, the strongest signal for potential benefit of dexamethasone was in patients with an eGFR<15 ml/min per 1.73 m(2). In conclusion, compared with placebo, intraoperative dexamethasone appeared to reduce the incidence of severe AKI after cardiac surgery in those with advanced CKD.

Trial registration: NCT00293592.

Keywords: acute renal failure; cardiovascular; clinical trial; creatinine; dialysis; ischemia–reperfusion.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / prevention & control*
  • Acute Kidney Injury / therapy
  • Aged
  • Anti-Inflammatory Agents / administration & dosage*
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiopulmonary Bypass / adverse effects*
  • Dexamethasone / administration & dosage*
  • Female
  • Glomerular Filtration Rate
  • Hospital Mortality
  • Humans
  • Intraoperative Care
  • Male
  • Middle Aged
  • Renal Replacement Therapy
  • Severity of Illness Index


  • Anti-Inflammatory Agents
  • Dexamethasone

Associated data