Prediction of acute kidney injury after cardiac surgery from preoperative N-terminal pro-B-type natriuretic peptide

This chapter summarizes the pharmacological interventions that can be used in the prevention of acute kidney injury (AKI). These following interventions are discussed: the use and selection of vasopressors; the administration of loop diuretics and mannitol; vasodilating drugs including dopamine, atrial natriuretic peptide, nesiritide, fenoldopam, and adenosine antagonists. The role of N-acetylcysteine in the prevention of contrast-induced AKI and cardiac surgery is discussed. The chapter concludes with a summary of the potential role of insulin-like growth factor and erythropoietin in the prevention of AKI.

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Predictors of Post-Operative Acute Kidney Injury in relation with N-Terminal Pro-B-Type Natriuretic Peptide Level among Patients Undergoing Mitral Valve Replacement

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v8i2.57430 ◽

2021 ◽

Vol 8 (2) ◽

pp. 85-89

Author(s):

Md Tanvir Hossain ◽

Asraful Hoque ◽

Tasmin Rubayath ◽

Romena Rahman ◽

Abu Shadat Mohammad Saem Khan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Mitral Valve ◽

Valve Replacement ◽

Natriuretic Peptide ◽

Mitral Valve Replacement ◽

Kidney Injury ◽

Natriuretic Peptide Level ◽

Peptide Level ◽

Operative Variable

Background: The N-terminal Pro-B-type natriuretic peptide (NT-proBNP) level can be utilized as post-operative prediction models suring cardiac surgery. Objective: The objective was to find out the predictors of post-operative acute kidney injury in relation with N-Terminal Pro-B-Type natriuretic peptide level among mitral valve replacement patients. Methodology: This cross-sectional study was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2018 to December 2019. Patients with the age of more than or equal to 18 years with both sexes who were underwent mitral valve replacement were selected as study population. Patients were divided into two groups based on pre-operative NT-proBNP level. Post-operatively patients were observed on the basis of post-operative serum creatinine. Results: A total number of 100 patients were recruited for this study of which 50 cases were in group A and the rest of 50 cases were in the group B. Elevated NT-proBNP was the most powerful and independent pre-operative variable in predicting post-operative AKI development (OR 0.999, 95% CI 0.998-1.00) Conclusion: In conclusion elevated NT-proBNP is the most powerful and independent pre-operative variable in predicting post-operative acute kidney injury. Journal of Current and Advance Medical Research, July 2021;8(2):85-89

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Preoperative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after non-cardiac surgery: A retrospective cohort study

10.21203/rs.2.23625/v1 ◽

2020 ◽

Author(s):

Bingcheng Zhao ◽

Pei-Pei Zhuang ◽

Shao-Hui Lei ◽

Shi-Da Qiu ◽

Xiao Yang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Natriuretic Peptide ◽

Area Under The Curve ◽

Kidney Injury ◽

Clinical Variables ◽

Net Reclassification Improvement ◽

Predictive Role ◽

Poor Outcomes ◽

Integrated Discrimination Improvement

Abstract Background Acute kidney injury (AKI) is associated with poor outcomes after non-cardiac surgery. Whether preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts AKI after non-cardiac surgery is unclear. Methods We conducted a retrospective study on patients whose NT-proBNP concentrations were measured before non-cardiac surgery at a tertiary academic hospital between 2008 and 2018. Multivariable logistic regression was used to investigate the predictive role of preoperative NT-proBNP on postoperative AKI defined by the Kidney Disease: Improving Global Outcomes creatinine criteria. Results Some 6.1% (444 of 7248) of patients developed AKI within 1 week after surgery. Preoperative NT-proBNP was an independent predictor of AKI after adjustment for clinical variables (odd ratio comparing top to bottom quintiles 2.29, 95% confidence interval [CI] 1.47-3.65, p<0.001 for trend; odd ratio per 1-unit increment in natural log transformed NT-proBNP 1.27, 95% CI 1.16-1.39). Compared with clinical variables alone, the addition of NT-proBNP modestly improved the discrimination (change in area under the curve from 0.764 to 0.773, p=0.005) and reclassification (continuous net reclassification improvement 0.210, 95% CI 0.111-0.308; integrated discrimination improvement 0.0044, 95% CI 0.0016-0.0072) of AKI and non-AKI cases. Conclusions Preoperative NT-proBNP concentrations provided predictive information for AKI in a cohort of patients undergoing non-cardiac surgery, independent of and incremental to conventional risk factors. Prospective studies are required to confirm this finding and examine its clinical impact.

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