scholarly journals P0612UTILITY OF BODY COMPOSITION MONITORING (BCM) TO CORRELATE FLUID STATUS AND AKI IN PATIENTS UNDERGOING MAJOR CARDIAC SURGERY AND OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Rajeevalochana Parthasarathy ◽  
Madhusri Babu ◽  
Merina Alex ◽  
Preethi Nagesh ◽  
Milly Mathew ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Body Composition ◽  
Cardiac Surgery ◽  
Informed Consent ◽  
Fluid Overload ◽  
Statistical Significance ◽  
Extracellular Volume ◽  
Kidney Injury ◽  
The Body ◽  
Fluid Status

Abstract Background and Aims Technically assisted assessment of volume status before cardiac surgery may be useful to direct intraoperative fluid administration. Using a three-compartment physiologic tissue model, the body composition monitor (BCM, In Body) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of ‘normal’ extracellular volume. Fluid overload is a risk factor for infection, increased re intubation rates, pneumonia and acute kidney injury in these high risk patients. This study is planned to use BCM to assess fluid status in patients undergoing cardiac surgery and correlating it with the risk of AKI AIMS: To do BCM analysis of patients undergoing major cardiac surgery to assess fluid status and renal outcomes Primary Objective To use BCM to assess fluid status in patients undergoing cardiac surgery and correlate it with the risk of acute kidney injury Secondary Objectives To assess the correlation of fluid status obtained by BCM to assess 1. In hospital mortality in patients with and without AKI Method The studyis being conducted at Madras Medical Mission, Chennai. Time period : 1 year ( June 1 2019- May 31 2020) Inclusion criteria All consecutive patients above 18 years of age undergoing cardiac surgery Exclusion criteria 1. No informed consent 2. Patients having metal implants, pace makers 3. Pregnant and lactating mothers After informed consent, all adult patients undergoing cardiac surgery will have a BCM analysis done by the dietician .( Free of Charge) The BCM analysisInbody S10) will be done on Day 0( preoperative), Day 2 and Day 5 . Data will be collected according to a set proforma ( Attached) . Analysis will be performed using the SPSS platform. Results In this pilot study, 134 patients who underwent major cardiac surgery were enrolled. Of these 44 patients developed AKI as defined by KDIGO criteria( 22 Stage 1, 15 stage 2, and 7 stage 3). There was no statistical significance in the baseline characteristics when compared to age, gender, htn, ckd between patients with and without aki. Overhydration as measured by ECW/TBW ration of > 0.38 was significantly higher on day 2 and 5 in patients who developed AKI .(P<0.00, All 44 patients in aki versus 40 in the non aki group). The PBF, ICW, BMI nad overall BCM score was higher in patient with AKI ( p<0.00). 7 patients required RRT( 6 SLED and 1 Acute PD). There was 1 death in theAKI group. The mean duration of hospital stay was longer ( 14 +/- 5 vs 7 +/- 3.5 ) in the AKI grroup Conclusion There is not much data on BCM and fluid assessment in cardiac surgery patients. These patients have many risk factors and a failing heart and associated renal dysfunction in many makes it very difficult to guide volume therapy in these patients. Many of the so called standard objective measures in assessing volume are not fool- proof . This study will be one of the firsts from India to assess fluid status in these patients and help in guiding therapy and also knowing the outcomes of such an objective measurement

scholarly journals Acute Kidney Injury and Fluid Overload in Pediatric Cardiac Surgery

2019 ◽  
Vol 5 (4) ◽  
pp. 326-342
Author(s):  
Michael A. Carlisle ◽  
Danielle E. Soranno ◽  
Rajit K. Basu ◽  
Katja M. Gist
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Pediatric Cardiac Surgery

scholarly journals Association Between Syndecan-1, Fluid Overload, and Progressive Acute Kidney Injury After Adult Cardiac Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiarui Xu ◽  
Wuhua Jiang ◽  
Yang Li ◽  
Haoxuan Li ◽  
Xuemei Geng ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Predictive Ability ◽  
Endothelial Glycocalyx ◽  
Blood And Urine Samples ◽  
Poor Outcomes ◽  
Roc Area ◽  
Adult Cardiac Surgery

Background: Acute kidney injury (AKI) is a common complication after cardiac surgery and the prognosis of AKI worsens with the increase in AKI severity. Syndecan-1(SDC-1) is a biomarker of endothelial glycocalyx degradation. Fluid overload (FO) is associated with poor outcomes in AKI patients and may be related to the damage of endothelial function. This study aimed at demonstrating the association between elevated SDC-1, FO, and AKI progression.Methods: In this prospective study, we screened patients who underwent cardiac surgery and enrolled patients who experienced an AKI within 48 h after surgery from December 1, 2018 to January 31, 2019. Blood and urine samples were collected at the time of AKI diagnosis for plasma SDC-1 (pSDC-1) and urine SDC-1 (uSDC-1) measurements. Fluid balance (FB) = accumulated [fluid intake (L) - fluid output (L)]/body weight (kg) × 100%. FO was defined as FB > 5%. The primary endpoint was progressive AKI, defined as AKI progression from a lower to a higher stage. The patients were divided into progressive AKI group vs. non-progressive AKI group.Results: The quartiles of pSDC-1 concentration (117.3 [67.4, 242.3] ng/mL) showed a graded association with the incidence of progressive AKI, ranging from 5.0, 11.9, 32.6 to 52.4% (p for trend < 0.001). Multivariate logistic regression showed that increased pSDC-1 was an independent risk factor for progressive AKI. The AUC-ROC area of pSDC-1 concentration in predicting AKI progression was 0.847. Linear regression showed a positive correlation between FB and pSDC-1 concentration (R2 = 0.384, p < 0.001). In patients with FO, the progressive AKI incidence was significantly higher in the high pSDC-1 (≥117.3 ng/mL) subgroup than in the low pSDC-1 subgroup (58.3 vs. 17.6%, OR = 9.167, P = 0.005). In patients without FO, the progressive AKI incidence was also significantly higher in the high pSDC-1 subgroup with a lower odds ratio (30.4 vs. 7.4%, OR = 6.714, P = 0.002).Conclusion: Elevated pSDC-1 concentration was associated with progressive AKI after cardiac surgery and showed good predictive ability for progressive AKI. FB was related to the increase of pSDC-1. The interaction between pSDC-1 and FB may further aggravate the progression of AKI.

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.

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