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The following is a summary of “Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and CKD,” published in the January 2025 issue of Nephrology by Strom et al.
Chronic kidney disease (CKD) increases the risk of myocardial infarction and anemia. The optimal red blood cell transfusion threshold for patients with CKD and myocardial infarction remains unclear.
Researchers conducted a retrospective study to compare the effectiveness of liberal and restrictive red blood cell transfusion strategies in patients with CKD and myocardial infarction.
They compared baseline characteristics and 30-day and 6-month outcomes of 3,504 patients enrolled in the MINT trial, grouped by CKD status: no CKD (N = 1,279), CKD with eGFR 30-60 mL/min/1.73 m2 (N = 999), CKD with eGFR < 30 mL/min/1.73 m2 (N = 802), and CKD requiring dialysis (N = 415). Groups were compared by the assigned transfusion strategy.
The results showed no statistically significant interactions between CKD stage and transfusion strategy. Among non-dialysis patients with eGFR < 30 mL/min/1.73 m2, a restrictive strategy had a higher risk of 30-day death or recurrent myocardial infarction (risk difference [RD], 5.8%, 95% CI 0.4% to 11.2%) compared to a liberal strategy. In patients with eGFR 30-60 mL/min/1.73 m2, the risk was similar between strategies (RD, 3.7%, 95% CI -0.9% to 8.2%). Among dialysis-dependent patients, a restrictive strategy also showed similar risk (RD, -2.6%, 95% CI -10.0% to 4.8%) compared to a liberal strategy.
Investigators found that a liberal transfusion strategy was not worse than a restrictive strategy in patients with CKD. It was associated with less harm in subgroups not receiving dialysis.
Source: journals.lww.com/jasn/abstract/9900/restrictive_or_liberal_blood_transfusion_in.526.aspx
