Trial reportJournal of the American Society of Nephrology : JASN2019
Safety of a Restrictive versus Liberal Approach to Red Blood Cell Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial.
Trial report in Journal of the American Society of Nephrology : JASN, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- Restrictive versus liberal red blood cell transfusion strategies for cardiac surgery: a systematic review and meta-analysis of randomized controlled trials.Journal of cardiothoracic surgery · 2026Pooled it
- Transfusion thresholds for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2021Pooled it
- Perioperative Clinical Trials in AKI.Seminars in nephrology · 2020Pooled it
- Intraoperative hemodynamics and risk of cardiac surgery-associated acute kidney injury: An observation study and a feasibility clinical trial.Clinical and experimental pharmacology & physiology · 2023Trial
- Current perspectives and updates on transfusion strategies in critically ill anemic patients.Frontiers in medicine · 2026Review
- Blood transfusion and acute kidney injury after cardiac surgery: a retrospective observational study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025Observational
- Quality of registration and adherence to guidelines for blood management in CABG surgeries: a case study.Journal of cardiothoracic surgery · 2025Article
- Article
- Blood transfusion reactions and risk of acute kidney injury and major adverse kidney events.Journal of nephrology · 2024Article
- Perioperative Acute Kidney Injury: Implications, Approach, Prevention.Advances in anesthesia · 2023Review
- Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management.Anesthesiology · 2023Review
- Acute kidney injury in Jamaicans with sickle cell disease hospitalized with COVID-19 infection.EJHaem · 2023Article
- Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review.European journal of medical research · 2023Review
- Longitudinal hemoglobin trajectories and acute kidney injury in patients undergoing cardiac surgery: a retrospective cohort study.Frontiers in cardiovascular medicine · 2023Article
- Interaction of hemoglobin, transfusion, and acute kidney injury in patients undergoing cardiopulmonary bypass: a group-based trajectory analysis.Renal failure · 2022Article
- Acute kidney injury following cardiopulmonary bypass in Jamaica.JTCVS open · 2022Article
- Higher Mean Arterial Pressure during Cardiopulmonary Bypass May Not Prevent Acute Kidney Injury in Elderly Patients Undergoing Cardiac Surgery.International journal of clinical practice · 2022Article
- Relation between red blood cell distribution width and acute kidney injury in patients with sepsis.Einstein (Sao Paulo, Brazil) · 2022Article
- Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review.Journal of clinical medicine · 2020Review
- Focus on metabolism, acute kidney injury and its influence on systemic organs.Intensive care medicine · 2020Article
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Authors and funding
22 authors at 12 institutions in 5 countries.
Funding
Abstract
backgroundSafely 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.
methodsIn a prespecified kidney substudy of a randomized noninferiority trial, we compared a restrictive threshold for red blood cell transfusion (transfuse if hemoglobin<7.5 g/dl, intraoperatively and postoperatively) with a liberal threshold (transfuse if hemoglobin<9.5 g/dl in the operating room or intensive care unit, or if hemoglobin<8.5 g/dl on the nonintensive care ward). We studied 4531 patients undergoing cardiac surgery with cardiopulmonary bypass who had a moderate-to-high risk of perioperative death. The substudy's primary outcome was AKI, defined as a postoperative increase in serum creatinine of ≥0.3 mg/dl within 48 hours of surgery, or ≥50% within 7 days of surgery.
resultsPatients in the restrictive-threshold group received significantly fewer transfusions than patients in the liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer transfusions in the restricted-threshold group compared with the liberal-threshold group;
conclusionsAmong patients undergoing cardiac surgery, a restrictive transfusion approach resulted in fewer red blood cell transfusions without increasing the risk of AKI.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.