{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T21:47:21Z","timestamp":1792705641915,"version":"4.5.0"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"17","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,11,5]]},"abstract":"Importance<\/jats:title>Cardiac surgery\u2013<\/jats:bold>associated acute kidney injury (CSA-AKI) remains a significant problem following cardiopulmonary bypass (CPB). Various strategies are proposed to attenuate CSA-AKI, including extracorporeal blood purification (EBP), but little is known about the effect of EBP through an acrylonitrile-sodium methallylsulfonate\/polyethyleneimine membrane during CPB.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine whether the use of an EBP device in a nonemergent cardiac surgery population reduces CSA-AKI after CPB.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This double-blind, randomized clinical trial was conducted in 2 tertiary hospitals in Spain. Patients 18 years or older undergoing nonemergent cardiac surgery who were at high risk for CSA-AKI were enrolled from June 15, 2016, through November 5, 2021, with follow-up data through February 5, 2022. Of 1156 patients assessed, 343 patients were randomized (1:1) to either receive EBP or standard care.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Nonselective EBP device connected to the CPB circuit.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was the rate of CSA-AKI in the 7 days after randomization.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 343 patients randomized (169 to receive EBP and 174 to receive usual care), the mean (SD) age was 69 (9) years and 119 were females. The rate of CSA-AKI was 28.4% (95% CI, 21.7%-35.8%) in the EBP group vs 39.7% (95% CI, 32.3%-47.3%) in the standard care group (P<\/jats:italic>\u2009=\u2009.03), with an adjusted difference of 10.4% (95% CI, 2.3%-18.5%) using a log-binomial model (P<\/jats:italic>\u2009=\u2009.01). No significant differences (P<\/jats:italic>\u2009&amp;gt;\u2009.05) were observed in most of the predefined clinical secondary end points or post hoc exploratory end points. In a sensitivity analysis, EBP was found to be more effective in terms of CSA-AKI reduction in patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction (&amp;lt;40%), and lower body mass index (&amp;lt;30). No differences were observed between the groups in adverse events tracking.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The use of a nonselective EBP device connected to the CPB circuit in a nonemergent population of patients undergoing cardiac surgery was associated with a significant reduction of CSA-AKI in the first 7 days after surgery.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02518087<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2024.20630","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T12:31:05Z","timestamp":1728477065000},"page":"1446","source":"Crossref","is-referenced-by-count":69,"title":["Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery"],"prefix":"10.1001","volume":"332","author":[{"given":"Xos\u00e9","family":"P\u00e9rez-Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Facultat de Medicina Campus de Bellvitge 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