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151. sj-docx-2-cjk-10.1177_20543581221150676 – Supplemental material for Development and Validation of Patient Education Tools for Deprescribing in Patients on Hemodialysis

Author

Cho, Thomas Hyunwoo, Ng, Patrick C. K., Lefebvre, Melissa J., Desjarlais, Arlene, McCann, Dennis, Waldvogel, Blair, Tonelli, Marcello, Garg, Amit X., Wilson, JoAnne, Beaulieu, Monica, Marin, Judith, Orsulak, Cali, Talson, Melanie, Sharma, Monica, Feldberg, Jordanne, Bohm, Clara, and Battistella, Marisa

Subjects
Medicine
Abstract

Supplemental material, sj-docx-2-cjk-10.1177_20543581221150676 for Development and Validation of Patient Education Tools for Deprescribing in Patients on Hemodialysis by Thomas Hyunwoo Cho, Patrick C. K. Ng, Melissa J. Lefebvre, Arlene Desjarlais, Dennis McCann, Blair Waldvogel, Marcello Tonelli, Amit X. Garg, JoAnne Wilson, Monica Beaulieu, Judith Marin, Cali Orsulak, Melanie Talson, Monica Sharma, Jordanne Feldberg, Clara Bohm and Marisa Battistella in Canadian Journal of Kidney Health and Disease

Published
2023
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152. sj-docx-1-cjk-10.1177_20543581221150676 – Supplemental material for Development and Validation of Patient Education Tools for Deprescribing in Patients on Hemodialysis

Author

Cho, Thomas Hyunwoo, Ng, Patrick C. K., Lefebvre, Melissa J., Desjarlais, Arlene, McCann, Dennis, Waldvogel, Blair, Tonelli, Marcello, Garg, Amit X., Wilson, JoAnne, Beaulieu, Monica, Marin, Judith, Orsulak, Cali, Talson, Melanie, Sharma, Monica, Feldberg, Jordanne, Bohm, Clara, and Battistella, Marisa

Subjects
Medicine
Abstract

Supplemental material, sj-docx-1-cjk-10.1177_20543581221150676 for Development and Validation of Patient Education Tools for Deprescribing in Patients on Hemodialysis by Thomas Hyunwoo Cho, Patrick C. K. Ng, Melissa J. Lefebvre, Arlene Desjarlais, Dennis McCann, Blair Waldvogel, Marcello Tonelli, Amit X. Garg, JoAnne Wilson, Monica Beaulieu, Judith Marin, Cali Orsulak, Melanie Talson, Monica Sharma, Jordanne Feldberg, Clara Bohm and Marisa Battistella in Canadian Journal of Kidney Health and Disease

Published
2023
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153. sj-docx-1-cjk-10.1177_20543581231169608 – Supplemental material for Variation in Kidney Transplant Referral Across Chronic Kidney Disease Programs in Ontario, Canada

Author

Yohanna, Seychelle, Naylor, Kyla L., Luo, Bin, Dixon, Stephanie N., Bota, Sarah E., Kim, S. Joseph, Blake, Peter G., Elliott, Lori, Cooper, Rebecca, Knoll, Gregory A., Treleaven, Darin, Wang, Carol, and Garg, Amit X.

Subjects
Medicine
Abstract

Supplemental material, sj-docx-1-cjk-10.1177_20543581231169608 for Variation in Kidney Transplant Referral Across Chronic Kidney Disease Programs in Ontario, Canada by Seychelle Yohanna, Kyla L. Naylor, Bin Luo, Stephanie N. Dixon, Sarah E. Bota, S. Joseph Kim, Peter G. Blake, Lori Elliott, Rebecca Cooper, Gregory A. Knoll, Darin Treleaven, Carol Wang and Amit X. Garg in Canadian Journal of Kidney Health and Disease

Published
2023
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154. sj-docx-1-cjk-10.1177_20543581231154183 – Supplemental material for Magnesium and Fracture Risk in the General Population and Patients Receiving Dialysis: A Narrative Review

Author

Cowan, Andrea C., Clemens, Kristin K., Sontrop, Jessica M., Dixon, Stephanie N., Killin, Lauren, Anderson, Sierra, Acedillo, Rey R., Bagga, Amit, Bohm, Clara, Brown, Pierre Antoine, Cote, Brenden, Dev, Varun, Harris, Claire, Hiremath, Swapnil, Kiaii, Mercedeh, Lacson, Eduardo, Molnar, Amber O., Oliver, Matthew J., Parmar, Malvinder S., McRae, Jennifer M., Nathoo, Bharat, Quinn, Kathleen, Shah, Nikhil, Silver, Samuel A., Tascona, Daniel J., Thompson, Stephanie, Ting, Robert H., Tonelli, Marcello, Vorster, Hans, Wadehra, Davinder B., Wald, Ron, Wolf, Myles, and Garg, Amit X.

Subjects
Medicine
Abstract

Supplemental material, sj-docx-1-cjk-10.1177_20543581231154183 for Magnesium and Fracture Risk in the General Population and Patients Receiving Dialysis: A Narrative Review by Andrea C. Cowan, Kristin K. Clemens, Jessica M. Sontrop, Stephanie N. Dixon, Lauren Killin, Sierra Anderson, Rey R. Acedillo, Amit Bagga, Clara Bohm, Pierre Antoine Brown, Brenden Cote, Varun Dev, Claire Harris, Swapnil Hiremath, Mercedeh Kiaii, Eduardo Lacson Jr, Amber O. Molnar, Matthew J. Oliver, Malvinder S. Parmar, Jennifer M. McRae, Bharat Nathoo, Kathleen Quinn, Nikhil Shah, Samuel A. Silver, Daniel J. Tascona, Stephanie Thompson, Robert H. Ting, Marcello Tonelli, Hans Vorster, Davinder B. Wadehra, Ron Wald, Myles Wolf and Amit X. Garg in Canadian Journal of Kidney Health and Disease

Published
2023
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157. Oral curcumin in elective abdominal aortic aneurysm repair: a multicentre randomized controlled trial

Author

Garg, Amit X., Devereaux, P.J., Hill, Andrew, Sood, Manish, Aggarwal, Bharat, Dubois, Luc, Hiremath, Swapnil, Guzman, Randolph, Iyer, Vikram, James, Matthew, McArthur, Eric, Moist, Louise, Ouellet, George, Parikh, Chirag R., Schumann, Virginia, Sharan, Sumit, Thiessen-Philbrook, Heather, Tobe, Sheldon, Wald, Ron, Walsh, Michael, Weir, Matthew, and Pannu, Neesh

Subjects
Curcumin -- Health aspects, Aneurysmectomy -- Methods -- Patient outcomes, Abdominal aortic aneurysm -- Development and progression -- Care and treatment, Health
Abstract

BACKGROUND: Curcumin, a popular herbal supplement from the plant turmeric, has prevented ischemic reperfusion and toxin-induced injury in many animal studies and a single-centre randomized human trial. We sought to test whether perioperative oral curcumin (compared with placebo) affects the inflammatory response and risk of postrepair complications after elective abdominal aortic aneurysm repair in humans. METHODS: We conducted a parallel-group, randomized, placebo-controlled trial of patients from 10 hospitals in Canada who were scheduled to undergo elective repair of an unruptured abdominal aortic aneurysm (November 2011 to November 2014). Patients in the treatment group received perioperative oral curcumin (2000-mg doses 8 times over 4 d). Patients, health care providers and local research staff were unaware of the treatment assignment. The primary outcomes were median concentrations of 4 biomarkers indicating injury and inflammation (postoperative urine interleukin-18 and perioperative rise in serum creatinine, plasma W-terminal pro-B-type natriuretic peptide and plasma high-sensitivity C-reactive protein). RESULTS: Baseline characteristics were similar in the 2 groups (606 patients overall; median age 76 yr). More than 85% of patients in each group took more than 80% of their scheduled capsules. Neither curcumin nor placebo significantly affected any of the 4 biomarkers (p > 0.05 for all comparisons). Regarding the secondary outcomes, there was a higher risk of acute kidney injury with curcumin than with placebo (17% v. 10%, p = 0.01), but no between-group difference in the median length of hospital stay (5 v. 5 days, p > 0.9) or the risk of clinical events (9% v. 9%, p = 0.9). INTERPRETATION: Curcumin had no beneficial effects when used in elective abdominal aortic aneurysm repair. These findings emphasize the importance of testing turmeric and curcumin before espousing their health benefits, as is currently done in the popular media. Trial registration: ClinicalTrials.gov, no. NCT01225094., Many modern medicines come from plants. (1,2) Turmeric, a plant in the ginger family that is native to South Asia, has been used for centuries as a spice and traditional [...]

Published
2018
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159. Kidney function and the comparative effectiveness and safety of direct oral anticoagulants vs. warfarin in adults with atrial fibrillation: a multicenter observational study

Author

Jun, Min, primary, Scaria, Anish, additional, Andrade, Jason, additional, Badve, Sunil V, additional, Birks, Peter, additional, Bota, Sarah E, additional, Campain, Anna, additional, Djurdjev, Ognjenka, additional, Garg, Amit X, additional, Ha, Jeffrey, additional, Harel, Ziv, additional, Hemmelgarn, Brenda, additional, Hockham, Carinna, additional, James, Matthew T, additional, Jardine, Meg J, additional, Levin, Adeera, additional, McArthur, Eric, additional, Ravani, Pietro, additional, Shao, Selena, additional, Sood, Manish M, additional, Tan, Zhi, additional, Tangri, Navdeep, additional, Whitlock, Reid, additional, and Gallagher, Martin, additional

Published
2022
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161. Cancer Risk and Mortality in Patients With Kidney Disease: A Population-Based Cohort Study

Author

Kitchlu, Abhijat, primary, Reid, Jennifer, additional, Jeyakumar, Nivethika, additional, Dixon, Stephanie N., additional, Munoz, Alejandro Meraz, additional, Silver, Samuel A., additional, Booth, Christopher M., additional, Chan, Christopher T.M., additional, Garg, Amit X., additional, Amir, Eitan, additional, Kim, S. Joseph, additional, and Wald, Ron, additional

Published
2022
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171. Effect of Colchicine on the Risk of Perioperative Acute Kidney Injury: Clinical Protocol of a Substudy of the Colchicine for the Prevention of Perioperative Atrial Fibrillation Randomized Clinical Trial.

Author

Garg, Amit X., Cuerden, Meaghan, Cata, Juan, Chan, Matthew T. V., Devereaux, P. J., Fleischmann, Edith, Grande, Ascensión Martín, Kabon, Barbara, Landoni, Giovanni, Maziak, Donna E., McLean, Sean, Parikh, Chirag, Popova, Ekaterine, Reimer, Cara, Trujillo Reyes, Juan Carlos, Roshanov, Pavel, Sessler, Daniel I., Srinathan, Sadeesh, Sontrop, Jessica M., and Gonzalez Tallada, Anna

Published
2023
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173. Adverse events with quetiapine and clarithromycin coprescription: A population‐based retrospective cohort study.

Author

Yau, Kevin, McArthur, Eric, Jeyakumar, Nivethika, Tsobo Muanda, Flory, Kim, Richard B., Clemens, Kristin K., Wald, Ron, and Garg, Amit X.

Abstract

Background and Aims: Quetiapine is an atypical antipsychotic predominantly metabolized by the cytochrome P450 3A4 (CYP3A4) enzyme. We studied the risk of adverse events following coprescription of clarithromycin (a strong CYP3A4 inhibitor) versus azithromycin (not a CYP3A4 inhibitor) in quetiapine users. Materials and Methods: This was a population‐based retrospective cohort study from 2004 to 2020 in Ontario, Canada in adult quetiapine users newly co‐prescribed clarithromycin (n = 16,909) or azithromycin (n = 25,267). The primary outcome was the composite of hospital encounters with encephalopathy (defined as a diagnosis of delirium, disorientation, transient alteration of awareness, transient ischemic attack, or unspecified dementia), a fall, or a fracture within 30 days of new coprescription. Secondary outcomes were individual components of the composite outcome, hospital encounter with computed tomography (CT) head scan, and all‐cause mortality. Results: Coprescription of clarithromycin versus azithromycin with quetiapine was associated with a higher risk of the primary composite outcome (365 of 16,909 clarithromycin users [2.2%] vs. 309 of 16,929 azithromycin users [1.8%]; absolute risk increase, 0.34% [95% confidence interval, CI, 0.04–0.63]; relative risk [RR], 1.19 [95% CI, 1.02–1.38]). This was primarily driven by an increase in fragility fractures (78 of 16,909 clarithromycin users [0.5%] vs. 45 of 16,923 azithromycin users [0.3%]; absolute risk increase, 0.20% [95% CI, 0.07–0.32]; RR, 1.74 [95% CI, 1.21–2.52]). Hospital encounters with a CT head scan were higher in clarithromycin users (220 of 16,909 [1.3%] vs. 175 of 16,923 azithromycin users [1.0%]; absolute risk increase, 0.27% [95% CI, 0.04–0.50]; RR, 1.26 [95% CI, 1.04–1.54]), but there was no difference in hospital encounters with encephalopathy, falls, or all‐cause mortality between macrolide groups. Conclusion: Among adults taking quetiapine, concurrent use of clarithromycin compared with azithromycin was associated with a small but statistically greater 30‐day risk of a hospital encounter for encephalopathy, falls, or fracture, which was predominantly related to a higher rate of fragility fractures. [ABSTRACT FROM AUTHOR]

Published
2023
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174. Trimethoprim-sulfamethoxazole and the risk of a hospital encounter with hyperkalemia: a matched population-based cohort study.

Author

Hwang, Y Joseph, Muanda, Flory T, McArthur, Eric, Weir, Matthew A, Sontrop, Jessica M, Lam, Ngan N, and Garg, Amit X

Subjects
HYPERKALEMIA, ACUTE kidney failure, COHORT analysis, GLOMERULAR filtration rate, POISSON regression
Abstract

Background Trimethoprim-sulfamethoxazole (TMP-SMX) can cause hyperkalemia by reducing renal potassium excretion. We assessed the risk of hyperkalemia after initiating TMP-SMX versus amoxicillin and determined if this risk is modified by a patient's baseline kidney function [estimated glomerular filtration rate (eGFR)]. Methods We conducted a population-based cohort study in Ontario, Canada involving adults ≥66 years of age newly treated with TMP-SMX (n  = 58 999) matched 1:1 with those newly treated with amoxicillin (2008–2020). The primary outcome was a hospital encounter with hyperkalemia defined by a laboratory serum potassium value ≥5.5 mmol/L within 14 days of antibiotic treatment. Secondary outcomes included a hospital encounter with acute kidney injury (AKI) and all-cause hospitalization. Risk ratios (RRs) were obtained using a modified Poisson regression. Results A hospital encounter with hyperkalemia occurred in 269/58 999 (0.46%) patients treated with TMP-SMX versus 80/58 999 (0.14%) in those treated with amoxicillin {RR 3.36 [95% confidence interval (CI) 2.62–4.31]}. The absolute risk of hyperkalemia in patients treated with TMP-SMX versus amoxicillin increased progressively with decreasing eGFR (risk difference of 0.12% for an eGFR ≥60 ml/min/1.73 m2, 0.42% for eGFR 45–59, 0.85% for eGFR 30–44 and 1.45% for eGFR <30; additive interaction P  < .001). TMP-SMX versus amoxicillin was associated with a higher risk of a hospital encounter with AKI [RR 3.15 (95% CI 2.82–3.51)] and all-cause hospitalization [RR 1.43 (95% CI 1.34–1.53)]. Conclusions The 14-day risk of a hospital encounter with hyperkalemia was higher in patients newly treated with TMP-SMX versus amoxicillin and the risk was highest in patients with a low eGFR. [ABSTRACT FROM AUTHOR]

Published
2023
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175. High-sensitivity Troponin I Predicts Major Cardiovascular Events after Non-Cardiac Surgery: A Vascular Events in Non-Cardiac Surgery Patients Cohort Evaluation (VISION) Substudy.

Author

Borges, Flavia K., Duceppe, Emmanuelle, Heels-Ansdell, Diane, Patel, Ameen, Sessler, Daniel I., Tandon, Vikas, Chan, Matthew, Pearse, Rupert, Srinathan, Sadeesh, Garg, Amit X., Sapsford, Robert J., Ofori, Sandra N., Marcucci, Maura, Kavsak, Peter A., Pettit, Shirley, Spence, Jessica, Belley-Cote, Emilie, McGillion, Michael, Whitlock, Richard, and Lamy, Andre

Published
2023
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178. Association between day of the week of elective surgery and postoperative mortality

Author

Dubois, Luc, Vogt, Kelly, Vinden, Chris, Winick-Ng, Jennifer, McClure, J. Andrew, Roshanov, Pavel S., Bell, Chaim M., and Garg, Amit X.

Subjects
Mortality -- Analysis -- Canada, Elective surgery -- Research -- Patient outcomes, Health
Abstract

BACKGROUND: In prior studies, higher mortality was observed among patients who had elective surgery on a Friday rather than earlier in the week. We investigated whether mortality after elective surgery was associated with day of the week of surgery in a Canadian population and whether the association was influenced by surgeon experience and volume. METHODS: We conducted a population-based retrospective cohort study in the province of Ontario, Canada. We included adults who underwent 1 of 12 elective daytime surgical procedures from Apr. 1, 2002, to Dec. 31, 2012. The primary outcome was 30-day mortality. We used generalized estimating equations to compare outcomes for surgeries performed on different days of the week, adjusting for patient and surgeon factors. RESULTS: A total of 402899 procedures performed by 1691 surgeons met our inclusion criteria. The median length of hospital stay was 6 (interquartile range 5-8) days. Surgeon experience varied significantly by day of week (p < 0.001), with surgeons operating on Fridays having the least experience. Nearly all of the patients who had their procedure on a Friday had postoperative care on the weekend, as compared with 49.1% of those whose surgery was on a Monday (p < 0.001). We found no difference in the 30-day mortality between procedures performed on Fridays and those performed on Mondays (adjusted odds ratio 1.08, 95% confidence interval 0.97-1.21). INTERPRETATION: Although surgeon experience differed across days of the week, the risk of 30-day mortality after elective surgery was similar regardless of which day of the week the procedure took place., In 3 prior studies, a higher risk of death was observed among patients who had elective surgery on a Friday than earlier in the week. (1-3) This 'weekday effect' was [...]

Published
2017
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183. Tranexamic Acid in Patients Undergoing Noncardiac Surgery

Author

Devereaux, P.J., primary, Marcucci, Maura, additional, Painter, Thomas W., additional, Conen, David, additional, Lomivorotov, Vladimir, additional, Sessler, Daniel I., additional, Chan, Matthew T.V., additional, Borges, Flavia K., additional, Martínez-Zapata, María J., additional, Wang, Chew Yin, additional, Xavier, Denis, additional, Ofori, Sandra N., additional, Wang, Michael K., additional, Efremov, Sergey, additional, Landoni, Giovanni, additional, Kleinlugtenbelt, Ydo V., additional, Szczeklik, Wojciech, additional, Schmartz, Denis, additional, Garg, Amit X., additional, Short, Timothy G., additional, Wittmann, Maria, additional, Meyhoff, Christian S., additional, Amir, Mohammed, additional, Torres, David, additional, Patel, Ameen, additional, Duceppe, Emmanuelle, additional, Ruetzler, Kurt, additional, Parlow, Joel L., additional, Tandon, Vikas, additional, Fleischmann, Edith, additional, Polanczyk, Carisi A., additional, Lamy, Andre, additional, Astrakov, Sergey V., additional, Rao, Mangala, additional, Wu, William K.K., additional, Bhatt, Keyur, additional, de Nadal, Miriam, additional, Likhvantsev, Valery V., additional, Paniagua, Pilar, additional, Aguado, Hector J., additional, Whitlock, Richard P., additional, McGillion, Michael H., additional, Prystajecky, Michael, additional, Vincent, Jessica, additional, Eikelboom, John, additional, Copland, Ingrid, additional, Balasubramanian, Kumar, additional, Turan, Alparslan, additional, Bangdiwala, Shrikant I., additional, Stillo, David, additional, Gross, Peter L., additional, Cafaro, Teresa, additional, Alfonsi, Pascal, additional, Roshanov, Pavel S., additional, Belley-Côté, Emilie P., additional, Spence, Jessica, additional, Richards, Toby, additional, VanHelder, Tomas, additional, McIntyre, William, additional, Guyatt, Gordon, additional, Yusuf, Salim, additional, and Leslie, Kate, additional

Published
2022
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189. Tranexamic Acid in Patients Undergoing Noncardiac Surgery

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Devereaux, P.J., Marcucci, Maura, Painter, Thomas W., Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I., Chan, Matthew T.V., Borges, Flavia K., Martínez-Zapata, María J., Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N., Wang, Michael K., Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo V., Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X., Short, Timothy G., Wittmann, Maria, Meyhoff, Christian S., Amir, Mohammed, Torres, David, Patel, Ameen, Duceppe, Emmanuelle, Ruetzler, Kurt, Parlow, Joel L., Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carisi A., Lamy, Andre, Astrakov, Sergey V., Rao, Mangala, Wu, William K.K., Bhatt, Keyur, de Nadal, Miriam, Likhvantsev, Valery V., Paniagua, Pilar, Aguado, Hector J., Whitlock, Richard P., McGillion, Michael H., Prystajecky, Michael, Vincent, Jessica, Eikelboom, John, Copland, Ingrid, Balasubramanian, Kumar, Turan, Alparslan, Bangdiwala, Shrikant I., Stillo, David, Gross, Peter L., Cafaro, Teresa, Alfonsi, Pascal, Roshanov, Pavel S., Belley-Côté, Emilie P., Spence, Jessica, Richards, Toby, VanHelder, Tomas, McIntyre, William, Guyatt, Gordon, Yusuf, Salim, Leslie, Kate, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Devereaux, P.J., Marcucci, Maura, Painter, Thomas W., Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I., Chan, Matthew T.V., Borges, Flavia K., Martínez-Zapata, María J., Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N., Wang, Michael K., Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo V., Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X., Short, Timothy G., Wittmann, Maria, Meyhoff, Christian S., Amir, Mohammed, Torres, David, Patel, Ameen, Duceppe, Emmanuelle, Ruetzler, Kurt, Parlow, Joel L., Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carisi A., Lamy, Andre, Astrakov, Sergey V., Rao, Mangala, Wu, William K.K., Bhatt, Keyur, de Nadal, Miriam, Likhvantsev, Valery V., Paniagua, Pilar, Aguado, Hector J., Whitlock, Richard P., McGillion, Michael H., Prystajecky, Michael, Vincent, Jessica, Eikelboom, John, Copland, Ingrid, Balasubramanian, Kumar, Turan, Alparslan, Bangdiwala, Shrikant I., Stillo, David, Gross, Peter L., Cafaro, Teresa, Alfonsi, Pascal, Roshanov, Pavel S., Belley-Côté, Emilie P., Spence, Jessica, Richards, Toby, VanHelder, Tomas, McIntyre, William, Guyatt, Gordon, Yusuf, Salim, and Leslie, Kate

Abstract

BACKGROUND Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding. METHODS We conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or placebo at the start and end of surgery (reported here) and, with the use of a partial factorial design, a hypotension-avoidance or hypertension-avoidance strategy (not reported here). The primary efficacy outcome was life-threatening bleeding, major bleeding, or bleeding into a critical organ (composite bleeding outcome) at 30 days. The pri- mary safety outcome was myocardial injury after noncardiac surgery, nonhemor- rhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism (composite cardiovascular outcome) at 30 days. To establish the noninferiority of tranexamic acid to placebo for the composite cardiovascular out- come, the upper boundary of the one-sided 97.5% confidence interval for the hazard ratio had to be below 1.125, and the one-sided P value had to be less than 0.025. RESULTS A total of 9535 patients underwent randomization. A composite bleeding outcome event occurred in 433 of 4757 patients (9.1%) in the tranexamic acid group and in 561 of 4778 patients (11.7%) in the placebo group (hazard ratio, 0.76; 95% confi- dence interval [CI], 0.67 to 0.87; absolute difference, −2.6 percentage points; 95% CI, −3.8 to −1.4; two-sided P<0.001 for superiority). A composite cardiovascular outcome event occurred in 649 of 4581 patients (14.2%) in the tranexamic acid group and in 639 of 4601 patients (13.9%) in the placebo group (hazard ratio, 1.02; 95% CI, 0.92 to 1.14; upper boundary of the one-sided 97.5% CI, 1.14; absolute difference, 0.3 per- centage points; 95% CI, −1.1 to 1.7; one-sided P=0.04 for noninferiority). CONCLUSIONS Among patients undergoing noncardiac surgery, the incidence of the com

Published
2022

190. Accelerated Surgery Versus Standard Care in Hip Fracture (HIP ATTACK-1): A Kidney Substudy of a Randomized Clinical Trial.

Author

UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, UCL - (SLuc) Service de médecine interne générale, Borges, Flavia K, Devereaux, P J, Cuerden, Meaghan, Sontrop, Jessica M, Bhandari, Mohit, Guerra-Farfán, Ernesto, Patel, Ameen, Sigamani, Alben, Umer, Masood, Neary, John, Tiboni, Maria, Tandon, Vikas, Ramokgopa, Mmampapatla Thomas, Sancheti, Parag, Lawendy, Abdel-Rahman, Balaguer-Castro, Mariano, Jenkinson, Richard, Ślęczka, Paweł, Nur, Aamer Nabi, Wood, Gavin C A, Feibel, Robert J, McMahon, John Stephen, Biccard, Bruce M, Ortalda, Alessandro, Szczeklik, Wojciech, Wang, Chew Yin, Tomás-Hernández, Jordi, Vincent, Jessica, Harvey, Valerie, Pettit, Shirley, Balasubramanian, Kumar, Slobogean, Gerard, Garg, Amit X, HIP ATTACK-1 Investigators, Veevaete, Laurent, Le Polain de Waroux, Bernard, Lavand'homme, Patricia, Cornu, Olivier, Tribak, Karim, Yombi, Jean Cyr, Touil, Nassim, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, UCL - (SLuc) Service de médecine interne générale, Borges, Flavia K, Devereaux, P J, Cuerden, Meaghan, Sontrop, Jessica M, Bhandari, Mohit, Guerra-Farfán, Ernesto, Patel, Ameen, Sigamani, Alben, Umer, Masood, Neary, John, Tiboni, Maria, Tandon, Vikas, Ramokgopa, Mmampapatla Thomas, Sancheti, Parag, Lawendy, Abdel-Rahman, Balaguer-Castro, Mariano, Jenkinson, Richard, Ślęczka, Paweł, Nur, Aamer Nabi, Wood, Gavin C A, Feibel, Robert J, McMahon, John Stephen, Biccard, Bruce M, Ortalda, Alessandro, Szczeklik, Wojciech, Wang, Chew Yin, Tomás-Hernández, Jordi, Vincent, Jessica, Harvey, Valerie, Pettit, Shirley, Balasubramanian, Kumar, Slobogean, Gerard, Garg, Amit X, HIP ATTACK-1 Investigators, Veevaete, Laurent, Le Polain de Waroux, Bernard, Lavand'homme, Patricia, Cornu, Olivier, Tribak, Karim, Yombi, Jean Cyr, and Touil, Nassim

Abstract

To the Editor: Acute kidney injury (AKI) is a lesser-known complication of hip fracture that may come about owing to decreased kidney perfusion and heightened inflammation from trauma, pain, bleeding, and fasting. Approximately 15%-20% of patients undergoing surgery for a hip fracture develop AKI, with 0.5%-1.8% receiving dialysis. [...]

Published
2022

191. Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury:A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial

Author

Garg, Amit X., Cuerden, Meaghan, Aguado, Hector, Amir, Mohammed, Belley-Cote, Emilie P, Bhatt, Keyur, Biccard, Bruce M., Borges, Flavia K., Chan, Matthew, Conen, David, Duceppe, Emmanuelle, Efremov, Sergey, Eikelboom, John, Fleischmann, Edith, Giovanni, Landoni, Gross, Peter, Jayaram, Raja, Kirov, Mikhail, Kleinlugtenbelt, Ydo, Kurz, Andrea, Lamy, Andre, Leslie, Kate, Likhvantsev, Valery, Lomivorotov, Vladimir, Marcucci, Maura, Martínez-Zapata, Maria José, McGillion, Michael, McIntyre, William, Meyhoff, Christian, Ofori, Sandra, Painter, Thomas, Paniagua, Pilar, Parikh, Chirag, Parlow, Joel, Patel, Ameen, Polanczyk, Carisi, Richards, Toby, Roshanov, Pavel, Schmartz, Denis, Sessler, Daniel, Short, Tim, Sontrop, Jessica M., Spence, Jessica, Srinathan, Sadeesh, Stillo, David, Szczeklik, Wojciech, Tandon, Vikas, Torres, David, Van Helder, Thomas, Vincent, Jessica, Wang, C. Y., Wang, Michael, Whitlock, Richard, Wittmann, Maria, Xavier, Denis, Devereaux, P. J., Garg, Amit X., Cuerden, Meaghan, Aguado, Hector, Amir, Mohammed, Belley-Cote, Emilie P, Bhatt, Keyur, Biccard, Bruce M., Borges, Flavia K., Chan, Matthew, Conen, David, Duceppe, Emmanuelle, Efremov, Sergey, Eikelboom, John, Fleischmann, Edith, Giovanni, Landoni, Gross, Peter, Jayaram, Raja, Kirov, Mikhail, Kleinlugtenbelt, Ydo, Kurz, Andrea, Lamy, Andre, Leslie, Kate, Likhvantsev, Valery, Lomivorotov, Vladimir, Marcucci, Maura, Martínez-Zapata, Maria José, McGillion, Michael, McIntyre, William, Meyhoff, Christian, Ofori, Sandra, Painter, Thomas, Paniagua, Pilar, Parikh, Chirag, Parlow, Joel, Patel, Ameen, Polanczyk, Carisi, Richards, Toby, Roshanov, Pavel, Schmartz, Denis, Sessler, Daniel, Short, Tim, Sontrop, Jessica M., Spence, Jessica, Srinathan, Sadeesh, Stillo, David, Szczeklik, Wojciech, Tandon, Vikas, Torres, David, Van Helder, Thomas, Vincent, Jessica, Wang, C. Y., Wang, Michael, Whitlock, Richard, Wittmann, Maria, Xavier, Denis, and Devereaux, P. J.

Abstract

Background: Most patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is <130 mmHg, all antihypertensive medications are withheld on the morning of surgery. If the SBP is ≥130 mmHg, some medications (but not angiotensin receptor blockers [ACEIs], angiotensin receptor blockers [ARBs], or renin inhibitors) may be continued in a stepwise manner. During surgery, the patients’ mean arterial pressure (MAP) is maintained at ≥80 mmHg. During the first 48 hours after surgery, some antihypertensive medications (but not ACEIs, ARBs, or renin inhibitors) may be restarted in a stepwise manner if the SBP is ≥130 mmHg. Control: Patients receive their usual antihypertensive medications before and after surgery. The patients’ MAP is maintained at ≥60 mmHg from anesthetic induction until the end of surgery. Setting: Recruitment from 108 centers in 22 countries from 2018 to 2021. Patients: Patients (~6800) aged ≥45 years having noncardiac surgery who have or are at risk of atherosclerotic disease and who routinely take antihypertensive medications. Measurements: The primary

Published
2022

192. Rationale and design of the PeriOperative ISchemic Evaluation-3 (POISE-3):a randomized controlled trial evaluating tranexamic acid and a strategy to minimize hypotension in noncardiac surgery

Author

Marcucci, Maura, Painter, Thomas W., Conen, David, Leslie, Kate, Lomivorotov, Vladimir V., Sessler, Daniel, Chan, Matthew T.V., Borges, Flavia K., Martínez Zapata, Maria J., Wang, C. Y., Xavier, Denis, Ofori, Sandra N., Landoni, Giovanni, Efremov, Sergey, Kleinlugtenbelt, Ydo V., Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X., Short, Timothy G., Wittmann, Maria, Meyhoff, Christian S., Amir, Mohammed, Torres, David, Patel, Ameen, Duceppe, Emmanuelle, Ruetzler, Kurtz, Parlow, Joel L., Tandon, Vikas, Wang, Michael K., Fleischmann, Edith, Polanczyk, Carisi A., Jayaram, Raja, Astrakov, Sergey V., Rao, Mangala, VanHelder, Tomas, Wu, William K.K., Cheong, Chao Chia, Ayad, Sabry, Abubakirov, Marat, Kirov, Mikhail, Bhatt, Keyur, de Nadal, Miriam, Likhvantsev, Valery, Iglesisas, Pilar Paniagua, Aguado, Hector J., McGillion, Michael, Lamy, Andre, Whitlock, Richard P., Roshanov, Pavel, Stillo, David, Copland, Ingrid, Vincent, Jessica, Balasubramanian, Kumar, Bangdiwala, Shrikant I., Biccard, Bruce, Kurz, Andrea, Srinathan, Sadeesh, Petit, Shirley, Eikelboom, John, Richards, Toby, Gross, Peter L., Alfonsi, Pascal, Guyatt, Gordon, Belley-Cote, Emily, Spence, Jessica, McIntyre, William, Yusuf, Salim, Devereaux, P. J., Marcucci, Maura, Painter, Thomas W., Conen, David, Leslie, Kate, Lomivorotov, Vladimir V., Sessler, Daniel, Chan, Matthew T.V., Borges, Flavia K., Martínez Zapata, Maria J., Wang, C. Y., Xavier, Denis, Ofori, Sandra N., Landoni, Giovanni, Efremov, Sergey, Kleinlugtenbelt, Ydo V., Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X., Short, Timothy G., Wittmann, Maria, Meyhoff, Christian S., Amir, Mohammed, Torres, David, Patel, Ameen, Duceppe, Emmanuelle, Ruetzler, Kurtz, Parlow, Joel L., Tandon, Vikas, Wang, Michael K., Fleischmann, Edith, Polanczyk, Carisi A., Jayaram, Raja, Astrakov, Sergey V., Rao, Mangala, VanHelder, Tomas, Wu, William K.K., Cheong, Chao Chia, Ayad, Sabry, Abubakirov, Marat, Kirov, Mikhail, Bhatt, Keyur, de Nadal, Miriam, Likhvantsev, Valery, Iglesisas, Pilar Paniagua, Aguado, Hector J., McGillion, Michael, Lamy, Andre, Whitlock, Richard P., Roshanov, Pavel, Stillo, David, Copland, Ingrid, Vincent, Jessica, Balasubramanian, Kumar, Bangdiwala, Shrikant I., Biccard, Bruce, Kurz, Andrea, Srinathan, Sadeesh, Petit, Shirley, Eikelboom, John, Richards, Toby, Gross, Peter L., Alfonsi, Pascal, Guyatt, Gordon, Belley-Cote, Emily, Spence, Jessica, McIntyre, William, Yusuf, Salim, and Devereaux, P. J.

Abstract

Background: For patients undergoing noncardiac surgery, bleeding and hypotension are frequent and associated with increased mortality and cardiovascular complications. Tranexamic acid (TXA) is an antifibrinolytic agent with the potential to reduce surgical bleeding; however, there is uncertainty about its efficacy and safety in noncardiac surgery. Although usual perioperative care is commonly consistent with a hypertension-avoidance strategy (i.e., most patients continue their antihypertensive medications throughout the perioperative period and intraoperative mean arterial pressures of 60 mmHg are commonly accepted), a hypotension-avoidance strategy may improve perioperative outcomes. Methods: The PeriOperative Ischemic Evaluation (POISE)-3 Trial is a large international randomized controlled trial designed to determine if TXA is superior to placebo for the composite outcome of life-threatening, major, and critical organ bleeding, and non-inferior to placebo for the occurrence of major arterial and venous thrombotic events, at 30 days after randomization. Using a partial factorial design, POISE-3 will additionally determine the effect of a hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of major cardiovascular events, at 30 days after randomization. The target sample size is 10,000 participants. Patients ≥45 years of age undergoing noncardiac surgery, with or at risk of cardiovascular and bleeding complications, are randomized to receive a TXA 1 g intravenous bolus or matching placebo at the start and at the end of surgery. Patients, health care providers, data collectors, outcome adjudicators, and investigators are blinded to the treatment allocation. Patients on ≥ 1 chronic antihypertensive medication are also randomized to either of the two blood pressure management strategies, which differ in the management of patient antihypertensive medications on the morning of surgery and on the first 2 days after surgery, and in the ta

Published
2022

194. A Genome-Wide Association Study to Identify Single-Nucleotide Polymorphisms for Acute Kidney Injury

Author

Zhao, Bixiao, Lu, Qiongshi, Cheng, Yuwei, Belcher, Justin M., Siew, Edward D., Leaf, David E., Body, Simon C., Fox, Amanda A., Waikar, Sushrut S., Collard, Charles D., Thiessen-Philbrook, Heather, Ikizler, Alp T., Ware, Lorraine B., Edelstein, Charles L., Garg, Amit X., Choi, Murim, Schaub, Jennifer A., Zhao, Hongyu, Lifton, Richard P., and Parikh, Chirag R.

Published
2017
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198. Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery

Author

Greenberg, Jason H., Whitlock, Richard, Zhang, William R., Thiessen-Philbrook, Heather R., Zappitelli, Michael, Devarajan, Prasad, Eikelboom, John, Kavsak, Peter A., Devereaux, P. J., Shortt, Colleen, Garg, Amit X., and Parikh, Chirag R.

Subjects
Cardiopulmonary bypass -- Research -- Complications and side effects, Interleukins -- Research -- Physiological aspects, Acute kidney failure -- Research -- Risk factors, Health
Abstract

Background Children undergoing cardiac surgery may exhibit a pronounced inflammatory response to cardiopulmonary bypass (CPB). Inflammation is recognized as an important pathophysiologic process leading to acute kidney injury (AKI). The aim of this study was to evaluate the association of the inflammatory cytokines interleukin (IL)-6 and IL-10 with AKI and other adverse outcomes in children after CPB surgery. Methods This is a sub-study of the Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) cohort, including 106 children ranging in age from 1 month to 18 years undergoing CPB. Plasma IL-6 and IL-10 concentrations were measured preoperatively and postoperatively [day 1 (within 6 h after surgery) and day 3]. Results Stage 2/3 AKI, defined by at least a doubling of the baseline serum creatinine concentration or dialysis, was diagnosed in 24 (23 %) patients. The preoperative IL-6 concentration was significantly higher in patients with stage 2/3 AKI [median 2.6 pg/mL, interquartile range (IQR) 2.6 0.6-4.9 pg/mL] than in those without stage 2/3 AKI (median 0.6 pg/mL, IQR 0.6-2.2 pg/mL) (p = 0.03). After adjustment for clinical and demographic variables, the highest preoperative IL-6 tertile was associated with a sixfold increased risk for stage 2/3 AKI compared with the lowest tertile (adjusted odds ratio 6.41, 95 % confidence interval 1.16-35.35). IL-6 and IL-10 levels increased significantly after surgery, peaking postoperatively on day 1. First postoperative IL-6 and IL-10 measurements did not significantly differ between patients with stage 2/3 AKI and those without stage 2/3 AKI. The elevated IL-6 level on day 3 was associated with longer hospital stay (p = 0.0001). Conclusions Preoperative plasma IL-6 concentration is associated with the development of stage 2/3 AKI and may be prognostic of resource utilization. Electronic supplementary material The online version of this article (doi:10.1007/s00467-015-3088-4) contains supplementary material, which is available to authorized users., Author(s): Jason H. Greenberg[sup.1] [sup.2] , Richard Whitlock[sup.6] , William R. Zhang[sup.2] , Heather R. Thiessen-Philbrook[sup.3] , Michael Zappitelli[sup.4] , Prasad Devarajan[sup.5] , John Eikelboom[sup.6] , Peter A. Kavsak[sup.7] , [...]

Published
2015
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