Cardiothoracic & vascular anesthesia
Blood transfusion and acute kidney injury after cardiac surgery: a retrospective observational study
Authors' conclusion
This study confirms previous findings that RBC transfusion is associated with postoperative AKI in cardiac surgery patients. The association was strongest among patients who received > 2 units of RBCs.
Study context
- Population
- Adults undergoing nonemergent on-pump cardiac surgery, Toronto General Hospital, 2016–2021798 developed acute kidney injury (AKI)
- Participants
- 5,204 adults
- Exposure
- Red blood cell (RBC) transfusion vs no RBC
- Outcome
- Postoperative AKI (KDIGO criteria), stage 1 and stage 2-3
Methodological detailsinverse probability weighted logistic regression, single-centre, external validation
- Inverse probability weighted logistic regression
- Single-centre
- External validation
Main finding
As reported in the abstract
AKI by RBC units transfused
1-2 RBC units vs no RBC: increased probability of stage 1 AKI
4%
1-2 RBC units vs no RBC: increased probability of stage 2-3 AKI
2%
> 2 RBC units: raised probability of stage 1 AKI
12%
> 2 RBC units: raised probability of stage 2-3 AKI
9%
Observational data: associations, not effects.
Further findings
AKI stage distribution among AKI patients
- Stage 1
- 77%
- Stage 2
- 11%
- Stage 3
- 12%
Blood product use
- RBCs administered
- 37%
- Plasma
- 14%
- Platelets
- 32%
Characteristics of AKI patients
- Older, lower preoperative hemoglobin and eGFR, longer CPB duration, lower intraoperative hemoglobin
Original publication
Blood transfusion and acute kidney injury after cardiac surgery: a retrospective observational study. Can J Anaesth. Published 29 July 2025. doi:10.
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