Influence of Erythrocyte Transfusion on the Risk of Acute Kidney Injury After Cardiac Surgery Differs in Anemic and Nonanemic Patients

2012 ◽  
Vol 56 (4) ◽  
pp. 164-165
Author(s):  
Keyvan Karkouti ◽  
Duminda N. Wijeysundera ◽  
Terrence M. Yau ◽  
Stuart A. Mc Cluskey ◽  
Christopher T. Chan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Erythrocyte Transfusion

scholarly journals Influence of Erythrocyte Transfusion on the Risk of Acute Kidney Injury after Cardiac Surgery Differs in Anemic and Nonanemic Patients

2011 ◽  
Vol 115 (3) ◽  
pp. 523-530 ◽  
Author(s):  
Keyvan Karkouti ◽  
Duminda N. Wijeysundera ◽  
Terrence M. Yau ◽  
Stuart A. McCluskey ◽  
Christopher T. Chan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Propensity Score ◽  
Conditional Logistic Regression ◽  
Kidney Injury ◽  
Erythrocyte Transfusion ◽  
Preoperative Anemia ◽  
Chi Square ◽  
Propensity Score Methods ◽  
Chi Square Test

Background Acute kidney injury (AKI) after cardiac surgery is a major health issue. Two important risk factors for AKI are preoperative anemia and perioperative erythrocyte transfusion, and elucidating their relationship may help in devising preventive strategies. Methods In this cohort study of 12,388 adults who underwent cardiac surgery with cardiopulmonary bypass and received three units or less of erythrocytes on the day of surgery, the authors used propensity score methods and conditional logistic regression to explore the relationship between preoperative anemia (hemoglobin less than 12.5 g/dL), erythrocyte transfusion on the day of surgery, and AKI (more than 50% decrease in estimated glomerular filtration rate from preoperative to postoperative day 3-4). Results AKI occurred in 4.1% of anemic patients (n = 94/2,287) and 1.6% of nonanemic patients (n = 162 of 10,101) (P < 0.0001). In the 2,113 propensity-score matched pairs, anemic patients had higher AKI rates than nonanemic patients (3.8% vs. 2.0%; P = 0.0007). AKI rates increased in direct proportion to the amount of erythrocytes transfused, and this increase was more pronounced in anemic patients: in anemic patients, the rate increased from 1.8% among those not transfused to 6.6% among those transfused three units (chi-square test for trend P < 0.0001), whereas in nonanemic patients, it increased from 1.7% among those not transfused to 3.2% among those transfused three units (chi-square test for trend P = 0.1). Conclusions Anemic patients presenting for cardiac surgery are more susceptible to transfusion-related AKI than nonanemic patients. Interventions that reduce perioperative transfusions may protect anemic patients against 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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