scholarly journals SO020NEPHROLOGY INTERVENTION IN PATIENTS AWAITING CARDIAC SURGERY: A RANDOMISED CONTROLLED TRIAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sergi Codina ◽  
Ana Coloma ◽  
Fabrizio Sbraga ◽  
Enric Boza ◽  
Jose Maria Vazquez-Reveron ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Controlled Trial ◽  
Kidney Injury ◽  
Categorical Variables

Abstract Background and Aims Acute kidney injury (AKI) is a frequent complication after cardiac surgery. Its incidence ranges from 19 to 44% depending on the study and which definition is used. There are some well-known risk factors associated with AKI, including baseline patient characteristics (age and comorbidities), need of perioperative blood transfusion or presence of previous chronic kidney disease. We wanted to evaluate if a nephrologist management and control of potential risk factors of renal disease can be used to prevent AKI, thereby minimizing the risk of need RRT, reducing costs and improving survival in these patients. It will be the first study focused on this intervention. The aim of this study is to assess if a nephrology intervention before cardiac surgery can reduce the postoperative incidence of AKI. Method Unicentric prospective randomized controlled trial of 298 participants from 2015 to 2019. The inclusion criteria was patients undergoing scheduled cardiac surgery of > 18 years old. The exclusion criteria was a requirement for renal replacement therapy before surgery. Clinical Research Ethics Committee of Bellvitge has approved the study before initiation. All patients have given written informed consent. We have done an intention-to-treat analysis, continuous variables have been compared between groups using Student's t test and categorical variables using X2. Results Nephrology intervention before surgery, included a preoperative study done minimum 1 month before the surgery to optimize the patient’ s overall condition by optimization of hydration state, remove or minimize dose of drugs that potentially deteriorate kidney function and correct metabolic disorders. No differences in the characteristics of the patients between groups was found (Table 1). The number of patients with AKI were 49 without differences between groups (0.112), with most of them presenting a stage 1 AKI, only 3 patients present a stage 3 AKI, but none of them required renal replacement therapy (Table 2). We found 1.3% of mortality (1 participant in the intervention group and 3 in control group). Data at 1 year follow-up (n= 144) showed low incidence of kidney disease (creatinine in intervention arm 91.87±30.79μmol/L and in control arm 87.08±23.58, p=0.292) without differences in albuminuria. Conclusion In summary, we did not find any difference in acute kidney injury and death when a nephrology intervention is done to cardiac surgery patients, probably it would be necessary to increase the sample size to make conclusions. The results at 1 year follow-up showed no kidney disease in these patients.

scholarly journals Acute Kidney Injury After Cardiac Surgery - Risk Factors for Renal Replacement Therapy

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Lahdenperä N-I ◽  
Suojaranta-Ylinen RT ◽  
Nisula S ◽  
Schramko AA
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury

scholarly journals Incidence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia

2020 ◽  
Author(s):  
Jonny Jonny ◽  
Moch Hasyim ◽  
Vedora Angelia ◽  
Ayu Nursantisuryani Jahya ◽  
Lydia Permata Hilman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Predictive Score ◽  
Apache Ii Score ◽  
Intermittent Hemodialysis ◽  
Factors Associated

Abstract Background : Currently, there is limited epidemiology data on acute kidney injury (AKI) in Indonesia.Therefore, we assessed the incidence of AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : Demographic and clinical data were collected from 952 ICU participants. The participants were categorized into AKI and non-AKI groups. The participants were further classified according to the 3 different stages of AKI as per the Kidney Disease Improving Global Outcome (KDIGO) criteria. Results : Overall incidenceof AKI was 43%. The participants were divided into three groups based on the AKI stages: 18.5% had stage 1, 33% had stage 2, and 48.5% had stage 3. Primary diagnosis of renal disease and high APACHE II score were the risk factors associated with AKI (OR = 4.53, 95% CI: 1.67-12.33, p=0.003 and OR = 1.14 per 1 unit increase, 95% CI: 1.09-1.20, p<0.001, respectively).Chronic kidney disease was the risk factor for severe AKI. Sepsis was the leading cause of AKI.Among the AKI participants, 24.6% required RRT. The most common RRT modalities were intermittent hemodialysis (71.7%), followed by slow low-efficiency dialysis (22.8%), continuous renal replacement therapy (4.3%), and peritoneal dialysis (1.1%). Conclusions : This study showed that AKI was a common problem in the Indonesian ICU. We strongly believe that identification of the risk factors associated with AKI will help us develop a predictive score for AKI so we can prevent and improve AKI outcome in the future.

MO405RISC FACTORS FOR CARDIAC SURGERY-ASSOCIATED ACUTE KIDNEY INJURY IN A TERTIARY REFERRAL HOSPITAL

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alvaro Lucas ◽  
Ali­cia Molina Andujar ◽  
Eduard Quintana ◽  
Gaston Piñeiro ◽  
Esteban Poch
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Extracorporeal Circulation ◽  
Kidney Injury ◽  
Preventive Strategies ◽  
Factors Associated ◽  
Ischaemia Time

Abstract Background and Aims cardiac surgery-associated acute kidney injury (CS-AKI) is a frequent complication that confers significant increase in morbility and mortality. It is still unclear how to identify patients at high risk to develop it, in order to apply to them early preventive strategies to avoid AKI. The study aimed to explore risk factors associated to CS-AKI. Method to analyze the association between demographic, pre-operative and intraoperative variables with all grades-AKI, we collected baseline characteristics, type of surgery, aortic time of clampage and extracorporeal circulation time, hemodinamic variables during surgery, Euroscore II, Clevelant Clinic Score and Leicester cardiosurgery score. The post-operative variables included monitorization of the first 24 h in the Intensive Care Units (ICU), consistent in: use of vasoactive drugs, total diuresis, use of furosemide, need of transfusions and need and duration of renal replacement therapy (RRT). Creatinine was collected for all the admision days in order to calculate the incidence of AKI. Also mortality and need of RRT at 30 th day was assessed. The inclusion criteria were: patients over 18 years old who underwent cardiac surgery with extracorporeal circulation. Only valve substitution (VS), Coronary Artery Bypass Graft (CABG) or a combination of both procedures (not including endocarditis surgery) were included. Patients who were already in dialysis or suffered an AKI just before the surgery were not included in the study. Results we included 130 patients who underwent heart surgery intervention in Hospital Clínic de Barcelona from 1st January to 31 st March 2015. 61,5% were men and the majority of them was 60 - 75 years old (46.9%), with hypertension (80.8%), without diabetes (68.5%), with stage 2-Chronic Kidney Disease (53.1%). Main surgical procedure was CABG (50.8%), followed by valve substitution (36.1%) and combination of both (13.1%). 73,1% of the procedures were done electively and 26.9% urgently. Out of the 130 patients, 60 (46.2%) suffered an AKI (36 AKIN 1, 16 AKIN 2 and 8 AKIN3). The majority of the episodes (55.2%) started between 24 and 48 hours after the intervention and 7 patients required RRT. AKI was not associated with mortality or need of renal replacement therapy at 30 days (OR 1.853, p= 0.397). Regarding risk factors for CS-AKI, basal eGFR &lt;60 ml/min, history of hypertension, age and the clevelant/leicester and euroscore were preoperative risk factors associated with CS-AKI in our cohort (OR 5.571 p=&lt;0.001; OR 2.621 p=0.043; OR 1.036 p&lt;0.001; OR 1.453 p=0.045; OR 1.062 p&lt;0.001; OR 1.351 p=0.006 respectively). Leicester cardiosurgery score &gt;30 was the score who showed the best association with AKI (OR 5.167, p&lt;0.001). Intraoperative significant risk factors that were identified were: ischaemia time over 70 minutes (OR 2.876, p=0.004), and the need to use phenylephrine (3.064, p=0.015); whereas the need to use nitroglycerin was identified as a protector (OR 0.441, p=0.031). Conclusion previous eGFR&lt;60 ml/min, age, hypertension, use of phenylephrine during surgery and long ischaemia time are the main factors associated with CS-AKI. Scores like Leicester score can help physicians to identify people at risk and apply preventive strategies.

scholarly journals Perioperative risk factors for delirium development after elective cardiovascular surgery

2020 ◽  
Vol 24 (2) ◽  
pp. 83
Author(s):  
V. V. Pasyuga ◽  
D. A. Demin ◽  
I. L. Nudel ◽  
E. V. Demina ◽  
A. V. Kadykova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Conflict Of Interest ◽  
Kidney Injury ◽  
Perioperative Risk ◽  
Perioperative Risk Factors

<p><strong>Aim.</strong> This study was conducted to determine the incidence of delirium after cardiac surgery and its effect on the length of the patient’s stay in the ICU and to identify the perioperative risk factors.<br /><strong>Methods.</strong> This research was a retrospective assessment of 1941 medical records and the course of the perioperative period in patients subjected to elective cardiac surgery.<br /><strong>Results.</strong> Delirium developed in 193 cases (9.94%); whereas, hyperactive, hypoactive and mixed delirium was observed in 13%, 43% and 44% of the patients, respectively. Most often (26% of the cases), delirium occurred after complex combined surgeries. Independent risk factors for the development of delirium were older age (OR 1.041, 95% CI [1.002–1.081], p = 0.038), EuroSCORE II score (OR 1.286, 95% CI [1.093–1.731], p = 0.025), acute kidney injury (OR 1.306, 95% CI [1.107–1.942], p = 0.0018) and renal replacement therapy (OR 1.399 95% CI [1.361–2.792], p = 0.001). Cardiopulmonary bypass duration and time of clamping of the aorta, postoperative serum creatinine level, need for blood transfusions and duration of mechanical ventilation and duration of ICU stay were identified as predictors and were also significantly higher in the delirium group. Delirium was closely associated with critical illness polyneuropathy (OR 9.201, 95% CI [2.13–38.826], p &lt; 0.001) and neurogenic dysphagia (OR 7.48, 95% CI [1.12–56.07], p = 0.022).<br /><strong>Conclusion.</strong> The key factors for delirium development in the postoperative period include advanced age, high EuroSCORE II scale and acute kidney injury requiring continuous renal replacement therapy. Delirium significantly increases the duration of mechanical ventilation and the duration of ICU stay.</p><p>Received 30 January 2020. Revised 18 March 2020. Accepted 24 March 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: V.V. Pasyuga, I.N. Leiderman<br />Data collection: D.A. Demin, E.V. Demina, I.L. Nudel, V.V. Pasyuga <br />Data analysis: V.V. Pasyuga, I.N. Leiderman, D.A. Demin, D.G. Tarasov<br />Drafting the article: V.V. Pasyuga, D.A. Demin<br />Critical revision of the article: I.N. Leiderman, A.V. Kadykova<br />Final approval of the version to be published: V.V. Pasyuga, D.A. Demin, I.L. Nudel, E.V. Demina, A.V. Kadykova, D.G. Tarasov, I.N. Leiderman</p>

Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

2016 ◽  
Vol 19 (3) ◽  
pp. 123 ◽  
Author(s):  
Orhan Findik ◽  
Ufuk Aydin ◽  
Ozgur Baris ◽  
Hakan Parlar ◽  
Gokcen Atilboz Alagoz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Albumin ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Preoperative Serum ◽  
Group I ◽  
Group Ii

<strong>Background:</strong> Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).<br /><strong>Methods:</strong> We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels &lt;3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.<br /><strong>Results:</strong> There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; <br />P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. <br /><strong>Conclusion:</strong> Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

scholarly journals Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU

2019 ◽  
Vol 41 (4) ◽  
pp. 462-471 ◽  
Author(s):  
Kellen Hyde Elias Pinheiro ◽  
Franciana Aguiar Azêdo ◽  
Kelsy Catherina Nema Areco ◽  
Sandra Maria Rodrigues Laranja
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Icu Patients ◽  
Septic Acute Kidney Injury ◽  
Observational Cohort ◽  
Worse Prognosis

Abstract Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. Aims: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. Methods: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. Results: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). Conclusions: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.

scholarly journals Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Medicine ◽  
2015 ◽  
Vol 94 (45) ◽  
pp. e2025 ◽  
Author(s):  
Jia-Rui Xu ◽  
Jia-Ming Zhu ◽  
Jun Jiang ◽  
Xiao-Qiang Ding ◽  
Yi Fang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Long Term Mortality
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