Risk Factors Profile for Acute Kidney Injury after Cardiac Surgery Is Different According to the Level of Baseline Renal Function

Objective: To evaluate the perioperative risk factors associated with postoperative AKI in patients undergoing cardiac surgery. Methodology: Between January 2011 and December 2017, we analyzed prospectively 544 patients, who were divided into two groups: patients with acute kidney injury associated with cardiac surgery (AKI-ACS) defined as an increase of 0.3 mg/dL or 1.5 times the baseline serum creatinine value and control group formed by patients without AKI-ACS. We compared patients and surgical variables using the chi-square test, Fisher's exact test, and mann-Whitney test and logistic regression. Results: AKI-ACS occurred in 29.8% of the patients. In the univariate analysis, the following variables presented a statistically significant difference: male gender (p=0.0087), age (p<0.0001), body mass (p=0.035), BMI (p=0.001), thoracic aortic surgery (p=0.029), use of extracorporeal circulation (p=0.012), CPB time (p=0.0001), aortic clamping time (p=0.0029), use of vasoactive drugs in post-operative period (p=0.017), preoperative kidney function (p<0.0001), presence of diabetes mellitus (p=0.008) and NYHA functional class (p=0.041). In the multivariate analysis, the following variables presented a statistical difference: male gender (OR 2.11), higher BMI (OR 2.11), worse preoperative renal function, demonstrated by creatinine clearance (OR 0.13), longer cardiopulmonary bypass (OR 1.008). Conclusion: The independent predictors for LRA-ACC were male gender, higher body mass index, worse preoperative renal function, and more complex surgeries associated with longer cardiopulmonary bypass.

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Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: A prospective multicenter study*

Critical Care Medicine ◽

10.1097/ccm.0b013e31821201d3 ◽

2011 ◽

Vol 39 (6) ◽

pp. 1493-1499 ◽

Cited By ~ 234

Author(s):

Simon Li ◽

Catherine D. Krawczeski ◽

Michael Zappitelli ◽

Prasad Devarajan ◽

Heather Thiessen-Philbrook ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Multicenter Study ◽

Kidney Injury ◽

Pediatric Cardiac Surgery ◽

Prospective Multicenter Study ◽

Incidence Risk

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Impact of Cardiac Function Improvement on Cardiac Surgery Associated Acute Kidney Injury for Patients with Preoperative Renal Dysfunction

10.21203/rs.3.rs-58733/v1 ◽

2020 ◽

Author(s):

Jiarui Xu ◽

Xin Chen ◽

Jing Lin ◽

Yang Li ◽

Bo Shen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiac Surgery ◽

Cardiac Function ◽

Renal Dysfunction ◽

Significant Risk ◽

Kidney Injury ◽

Normal Function ◽

Function Group ◽

Postoperative Aki

Abstract Background: We aim to investigate whether the postoperative cardiac function improve or not would affect the risk of cardiac surgery associated acute kidney injury (AKI) for patients with preoperative renal dysfunction. Method: Data from patients underwent cardiac surgery from April 2012 to February 2016 were collected. Renal dysfunction was defined as preoperative SCr >1.2 mg/dL (females) or >1.5 mg/dL (males). Patients were grouped as normal renal function group, renal dysfunction with chronic kidney disease (CKD group), and non CKD group. △LVEF=postoperative LVEF - preoperative LVEF. Cardiac function improved was defined as △LVEF ≥10. Patients were further divided into non CKD & cardiac function improved (non CKD+), non CKD & cardiac function not improved (non CKD-), CKD & cardiac function improved (CKD+) and CKD & cardiac function not improved (CKD-) subgroups.Results: A total of 8,661 patients were allocated as normal renal function (n=7,903), non CKD(n = 662) and CKD (n = 136) groups. Both non CKD and CKD groups had higher AKI incidence than normal function group (39.5% vs 30.0%, P < 0.001; 61.8% vs 30.0%, P<0.001), and non CKD+ group had the similar AKI incidence with normal function group (30.9% vs 30.0%, P=0.729). Multivariate logistic regression analysis revealed that non CKD-, CKD+ and CKD- were significant risk factors, whereas non CKD+ was not a significant risk factor for postoperative AKI. The SCr at discharge in non CKD+ subgroup was significantly lower than its preoperative SCr (1.4 ± 0.8 vs 1.7 ± 0.9 mg/dL, P = 0.020).Conclusions: For renal dysfunction patients with no CKD, the risk of postoperative AKI did not exist if the cardiac function improved after surgery. For CKD patients, the risk of postoperative AKI increase regardless whether the cardiac function improved or not.

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Preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in cardiac surgery patients

Medicinski pregled ◽

10.2298/mpns2002005g ◽

2020 ◽

Vol 73 (1-2) ◽

pp. 5-12

Author(s):

Miodrag Golubovic ◽

Andrej Preveden ◽

Ranko Zdravkovic ◽

Jelena Vidovic ◽

Bojan Mihajlovic ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Uric Acid ◽

Cardiac Surgery ◽

Kidney Injury ◽

C Reactive Protein ◽

Reactive Protein ◽

Preoperative Hemoglobin ◽

Significant Difference ◽

Acute Kidney Injury Development

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.

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Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

10.21203/rs.3.rs-100124/v1 ◽

2020 ◽

Author(s):

Benedict Morath ◽

Andreas Meid ◽

Johannes Rickmann ◽

Jasmin Soethoff ◽

Markus Verch ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiac Surgery ◽

Kidney Function ◽

Hydroxyethyl Starch ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Kidney Injury ◽

Retrospective Cohort Analysis ◽

The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

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