The Association Between Pulsatile Cardiopulmonary Bypass and Acute Kidney Injury After Cardiac Surgery: A Before-and-After Study

Abstract Background Systemic inflammation contributes to cardiac surgery–associated acute kidney injury (AKI). Cardiomyocytes and other organs experience hypothermia and hypoxia during cardiopulmonary bypass (CPB), which induces the secretion of cold-inducible RNA-binding protein (CIRP). Extracellular CIRP may induce a proinflammatory response. Materials and Methods The serum CIRP levels in 76 patients before and after cardiac surgery were determined to analyze the correlation between CIRP levels and CPB time. The risk factors for AKI after cardiac surgery and the in-hospital outcomes were also analyzed. Results The difference in the levels of CIRP (ΔCIRP) after and before surgery in patients who experienced cardioplegic arrest (CA) was 26-fold higher than those who did not, and 2.7-fold of those who experienced CPB without CA. The ΔCIRP levels were positively correlated with CPB time (r = 0.574, p < 0.001) and cross-clamp time (r = 0.54, p < 0.001). Multivariable analysis indicated that ΔCIRP (odds ratio: 1.003; 95% confidence interval: 1.000–1.006; p = 0.027) was an independent risk factor for postoperative AKI. Patients who underwent aortic dissection surgery had higher levels of CIRP and higher incidence of AKI than other patients. The incidence of AKI and duration of mechanical ventilation in patients whose serum CIRP levels more than 405 pg/mL were significantly higher than those less than 405 pg/mL (65.8 vs. 42.1%, p = 0.038; 23.1 ± 18.2 vs. 13.8 ± 9.2 hours, p = 0.007). Conclusion A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.

Download Full-text

Aqp2 may affect the occurrence of acute kidney injury after cardiopulmonary bypass

10.21203/rs.3.rs-64448/v1 ◽

2020 ◽

Author(s):

Yingjie Xiao ◽

Yanli Li ◽

Wenpeng Dong ◽

Long Gui ◽

Xu Yu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Postoperative Complications ◽

Kidney Injury ◽

Complete Recovery ◽

Upward Trend ◽

Before And After ◽

Postoperative Aki

Abstract BACKGROUND Acute kidney injury (AKI) is one of the most important postoperative complications of cardiac surgery, and despite complete recovery of renal function after surgery, AKI is independently associated with high mortality within 10 years after surgery. Experiments show that Aquaporin 2(AQP2) is associated with postoperative AKI. Results of AQP2 release patterns after acute kidney injury have not been the same in different studies. METHODS We selected all patients undergoing extracorporeal circulation surgery, collected their urine samples before and after surgery, centrifuged at 3000 rpm for ten minutes, and detected the expression of AQP2 in urine by ELISA. RESULTS Most of the patients without AKI showed an upward trend of AQP2, while the patients with AKI showed a downward trend of AQP2. Patients with lower AQP2 levels before surgery have a lower chance of developing AKI. CONCLUSION AQP2 can be used to predict and prevent postoperative AKI.

Download Full-text

Faculty Opinions recommendation of Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725330551.793503647 ◽

2015 ◽

Author(s):

Claudio Ronco ◽

Zaccaria Ricci

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Cardiopulmonary Bypass ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Case Control Study ◽

Kidney Injury ◽

Case Control ◽

Control Study

Download Full-text

Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload

Pediatric Nephrology ◽

10.1007/s00467-021-04976-2 ◽

2021 ◽

Author(s):

Dominic Zanaboni ◽

Jungwon Min ◽

Roopa Seshadri ◽

J. William Gaynor ◽

Molly Dreher ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Fluid Overload ◽

Kidney Injury

Download Full-text

Clinical and Operative Determinants of Acute Kidney Injury after Cardiac Surgery

Cardiorenal Medicine ◽

10.1159/000507777 ◽

2020 ◽

Vol 10 (5) ◽

pp. 340-352

Author(s):

Faeq Husain-Syed ◽

Maria Giovanna Quattrone ◽

Fiorenza Ferrari ◽

Pércia Bezerra ◽

Salvador Lopez-Giacoman ◽

...

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Cardiac Surgery ◽

Minimally Invasive Surgery ◽

Cardiopulmonary Bypass ◽

Minimally Invasive ◽

Invasive Surgery ◽

Fluid Balance ◽

Kidney Injury ◽

Baseline Serum

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with increased morbidity and mortality. Objectives: We aimed to identify potentially modifiable risk factors for CSA-AKI. Methods: This was asingle-center retrospective cohort study of 495 adult patients undergoing cardiac surgery. AKI was diagnosed and staged using full KDIGO criteria incorporating baseline serum creatinine (SC) levels and correction of postoperative SC levels for fluid balance. We examined the association of routinely available clinical and laboratory data with AKI using multivariate logistic regression modeling. Results: A total of 103 (20.8%) patients developed AKI: 16 (15.5%) patients were diagnosed with AKI upon hospital admission, and 87 (84.5%) patients were diagnosed with CSA-AKI. Correction of SC levels for fluid balance increased the number of AKI cases to 104 (21.0%), with 6 patients categorized to different AKI stages. Univariate logistic regression analysis identified five preoperative (age, sex, diabetes mellitus, preoperative systolic pulmonary arterial pressure [PSPAP], acute decompensated heart failure) and five intraoperative predictors of AKI (age, sex, red blood cell [RBC] volume transfused, use of minimally invasive surgery, duration of cardiopulmonary bypass). When all preoperative and intraoperative variables were incorporated into one model, six predictors remained significant (age, sex, use of minimally invasive surgery, RBC volume transfused, PSPAP, duration of cardiopulmonary bypass). Model discrimination performance showed an area under the curve of 0.69 for the model including only preoperative variables, 0.76 for the model including only intraoperative variables, and 0.77 for the model including all preoperative and intraoperative variables. Conclusions: Use of minimally invasive surgery and therapies mitigating PSPAP and intraoperative blood loss may offer protection against CSA-AKI.

Download Full-text