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.

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 Advance Targeted Transfusion in Anemic Cardiac Surgical Patients for Kidney Protection

2012 ◽  
Vol 116 (3) ◽  
pp. 613-621 ◽  
Author(s):  
Keyvan Karkouti ◽  
Duminda N. Wijeysundera ◽  
Terrence M. Yau ◽  
Stuart A. McCluskey ◽  
Christopher T. Chan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pilot Trial ◽  
Transferrin Saturation ◽  
Kidney Injury ◽  
Standard Of Care ◽  
Group Differences ◽  
Erythrocyte Transfusion ◽  
Preoperative Anemia ◽  
Parallel Group ◽  
Perioperative Anemia

Introduction : Acute kidney injury (AKI) is a serious complication of cardiac surgery, and preoperative anemia and perioperative erythrocyte transfusion are important risk factors. Prophylactic erythrocyte transfusion in anemic patients may, therefore, protect against AKI. Methods : In this unblinded, parallel-group, randomized pilot trial, 60 anemic patients (hemoglobin 10-12 g/dL) undergoing cardiac surgery with cardiopulmonary bypass were randomized (1:1) to prophylactic transfusion (2 units of erythrocytes transfused 1 to 2 days before surgery (n = 29) or standard of care (transfusions as indicated; n = 31). Between-group differences in severity of perioperative anemia, transfusion, and AKI (more than 25% drop in estimated glomerular filtration rate) were measured. The relationships between transfusion, iron levels, and AKI were also measured. Results : Perioperative anemia and erythrocyte transfusions were lower in the prophylactic transfusion group--median (25th, 75th percentiles) for nadir hemoglobin was 8.3 (7.9, 9.1) versus 7.6 (6.9, 8.2) g/dL (P = 0.0008) and for transfusion was 0 (0, 2) versus 2 (1, 4) units (P = 0.0002)--but between-group AKI rates were comparable (11 patients per group). In 35 patients with iron studies, perioperative transfusions were directly related to postoperative transferrin saturation (correlation coefficient 0.6; P = 0.0002), and high (more than 80%) transferrin saturation was associated with AKI (5/5 vs. 8/30; P = 0.005), implicating transfusion-related iron overload as a cause of AKI. Conclusions : In anemic patients, prophylactic erythrocyte transfusion reduces perioperative anemia and erythrocyte transfusions, and may reduce plasma iron levels. Adequately powered studies assessing the effect of this intervention on AKI are warranted.

scholarly journals Association of Prior to Intensive Care Unit Statin Use With Outcomes on Patients With Acute Kidney Injury

2021 ◽  
Vol 8 ◽  
Author(s):  
Boxiang Tu ◽  
Yuanjun Tang ◽  
Yi Cheng ◽  
Yuanyuan Yang ◽  
Cheng Wu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Propensity Score Methods ◽  
Statin Use

Purpose: To evaluate the association of prior to intensive care unit (ICU) statin use with the clinical outcomes in critically ill patients with acute kidney injury (AKI).Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV (version 1.0) database for this retrospective observational study. The primary outcome was 30-day intensive care unit (ICU) mortality. A 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by the multivariate Cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariate linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages.Results: We identified 3,821 pre-ICU statin users and 9,690 non-users. In multivariate model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [hazard ratio (HR) 0.68 (0.59, 0.79); p < 0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); p < 0.001] and ICU LOS [mean difference −0.51(−0.79, −0.24); p < 0.001]. The results were consistent in three propensity score methods. In subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, except for 30-day ICU mortality in AKI stage 1.Conclusion: Patients with AKI who were administered statins prior to ICU admission might have lower mortality during ICU and hospital stay and shorter ICU LOS.

scholarly journals Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis

Critical Care ◽  
2014 ◽  
Vol 18 (6) ◽  
Author(s):  
Anne Julie Frenette ◽  
Josée Bouchard ◽  
Pascaline Bernier ◽  
Annie Charbonneau ◽  
Long Thanh Nguyen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Kidney Injury ◽  
Albumin Administration ◽  
Score Analysis

scholarly journals Impact of Prior to Intensive Care Unit Statin use on Patients with Acute Kidney Injury

2021 ◽  
Author(s):  
Bo-Xiang Tu ◽  
Yuan-Jun Tang ◽  
Yi Cheng ◽  
Xiao-Bin Liu ◽  
Cheng Wu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Propensity Score Methods ◽  
Statin Use

Abstract Purpose: To evaluate if prior to intensive care unit (ICU) statin use improve the clinical outcomes, for critically ill patients with acute kidney injury (AKI).Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV v1.0 database for this retrospective observational study. The primary outcome was 30-day ICU mortality. 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by multivariable cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariable linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages.Results: 3821 pre-ICU statin users and 9690 non-users were identified. In multivariable model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [Hazara ratio (HR) 0.68 (0.59,0.79); P<0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); P<0.001] and ICU LOS [Mean Difference -0.51(-0.79, -0.24); P<0.001]. The conclusions were consistent in three propensity score methods. In Subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, only except for 30-day ICU mortality in AKI stage 1.Conclusions: Patients with AKI who were administered statins prior to ICU admission might have lower mortality rate during ICU or hospital stay and shorter ICU LOS.

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