Role of Body Mass Index in Acute Kidney Injury Patients after Cardiac Surgery

Background/Aims: To explore the association of body mass index (BMI) with the risk of developing acute kidney injury after cardiac surgery (CS-AKI) and for AKI requiring renal replacement therapy (AKI-RRT) after cardiac surgery. Methods: Clinical data of 8,455 patients undergoing cardiac surgery, including demographic preoperative, intraoperative, and postoperative data were collected. Patients were divided into underweight (BMI <18.5), normal weight (18.5≤ BMI <24), overweight (24≤ BMI <28), and obese (BMI ≥28) groups. The influence of BMI on CS-AKI incidence, duration of hospital, and intensive care unit (ICU) stays as well as AKI-related mortality was analyzed. Results: The mean age of the patients was 53.2 ± 13.9 years. The overall CS-AKI incidence was 33.8% (n = 2,855) with a hospital mortality of 5.4% (n = 154). The incidence of AKI-RRT was 5.2% (n = 148) with a mortality of 54.1% (n = 80). For underweight, normal weight, overweight, and obese cardiac surgery patients, the AKI incidences were 29.9, 31.0, 36.5, and 46.0%, respectively (p < 0.001). The hospital mortality of AKI patients in the 4 groups was 9.5, 6.0, 3.8, and 4.3%, whereas the hospital mortality of AKI-RRT patients in the 4 groups was 69.2, 60.8, 36.4, and 58.8%, both significantly different (p < 0.05). Hospital and ICU stay durations were not significantly different in the 4 BMI groups. Conclusion: The hospital prognosis of AKI and AKI-RRT patients after cardiac surgery was best when their BMI was in the 24-28 range.

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Effect of Body Mass Index on Acute Kidney Injury After Cardiac Surgery

Hong Kong Journal of Nephrology ◽

10.1016/j.hkjn.2015.09.065 ◽

2015 ◽

Vol 17 (2) ◽

pp. S96-S97

Author(s):

Zou Zhouping ◽

Xu Jiarui ◽

Fang Yi ◽

Zou Jianzhou ◽

Ding Xiaoqiang ◽

...

Keyword(s):

Body Mass Index ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Body Mass ◽

Kidney Injury

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Clinical Outcomes of Weight-Based Norepinephrine Dosing in Underweight and Morbidly Obese Patients: A Propensity-Matched Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066618768180 ◽

2018 ◽

Vol 35 (6) ◽

pp. 554-561 ◽

Cited By ~ 5

Author(s):

Aditya A. Kotecha ◽

Saraschandra Vallabhajosyula ◽

Dinesh R. Apala ◽

Erin Frazee ◽

Vivek N. Iyer

Keyword(s):

Body Mass Index ◽

Septic Shock ◽

Confidence Interval ◽

Hospital Mortality ◽

Body Mass ◽

Odds Ratio ◽

Kidney Injury ◽

Normal Weight ◽

Morbidly Obese ◽

Obese Patients

Background: Weight-based dosing strategy for norepinephrine in septic shock patients with extremes of body mass index has been lesser studied. Methods: This historical study of adult septic shock patients was conducted from January 1, 2010, to December 31, 2015, at all intensive care units (ICUs) in Mayo Clinic, Rochester. Patients with documented body mass index were classified into underweight (body mass index <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), and morbidly obese (≥40 kg/m2) patients. Patients with repeat ICU admissions, ICU stay <1 day, and body mass index 25 to 39.9 kg/m2 were excluded. The primary outcome was in-hospital mortality, and secondary outcomes included cumulative norepinephrine exposure acute kidney injury, cardiac arrhythmias, and 1-year mortality. Two-tailed P < .05 was considered statistically significant. Results: From 2010 to 2015, 2016 patients met inclusion—145, 1406, and 466 patients, respectively, in underweight, normal weight, and morbidly obese cohorts. Underweight patients used the highest peak dose and absolute exposure was greatest for morbidly obese patients. In-hospital mortality decreased with increasing log10 body mass index: 41.4% (underweight), 28.4% (normal weight), and 24.7% (morbidly obese), respectively ( P < .001); however, this relationship was not noted at 1 year. Unadjusted log10 norepinephrine cumulative exposure (mg) was associated with higher in-hospital mortality, acute kidney injury, cardiac arrhythmias, and 1-year mortality. After adjustment for demographics, body mass index, comorbidity, and illness severity, log10 norepinephrine exposure was an independent predictor of in-hospital mortality (odds ratio 2.4 [95% confidence interval, 2.0-2.8]; P < .001) and 1-year mortality (odds ratio 1.7 [95% confidence interval, 1.5-2.0]; P < .001). In a propensity-matched analysis of 1140 patients, log10 norepinephrine was an independent predictor of in-hospital mortality (odds ratio 2.2 [95% confidence interval, 1.8-2.6]; P < .001). Conclusions: Morbidly obese patients had lower in-hospital mortality but had higher 1-year mortality compared to normal weight and underweight patients. Cumulative norepinephrine exposure was highest in morbidly obese patients. Total norepinephrine exposure was an independent mortality predictor in septic shock.

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Intra-abdominal hypertension and increased acute kidney injury risk: a systematic review and meta-analysis

Journal of International Medical Research ◽

10.1177/03000605211016627 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110166

Author(s):

Jing Sun ◽

Hongjun Sun ◽

Zhijian Sun ◽

Xin Yang ◽

Shuhua Zhou ◽

...

Keyword(s):

Body Mass Index ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Body Mass ◽

Injury Risk ◽

Meta Analysis ◽

Kidney Injury ◽

Search Terms ◽

Abdominal Hypertension ◽

Associated Risk Factors

Objective The present meta-analysis aimed to determine the relationship between intra-abdominal hypertension (IAH) and an increased prevalence of acute kidney injury (AKI) and identify the associated risk factors in various patient populations, regardless of whether they were admitted to an intensive care unit. Methods We used three databases for the following search terms: “IAH,” “abdominal compartment syndrome,” “AKI,” “acute kidney failure,” and others. The articles retrieved were compared to identify appropriate studies published until 7 May 2020. The main outcome was AKI. Results Six studies with 344 individuals were included. The patients were divided into two main groups: the IAH and non-IAH groups. Compared with patients without IAH, patients with IAH had a higher risk of AKI (odds ratio = 2.57, 95% confidence interval: 1.55–4.26). In the subgroup and meta-regression analyses, body mass index, age, the presence or absence of burns, and cardiac surgery did not affect the risk of AKI. Conclusion IAH was associated with AKI risk, and this association was not influenced by age, body mass index, the presence or absence of burns, or cardiac surgery.

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Impact of body mass index on hospital mortality and postoperative complications in a recent cohort of patients undergoing cardiac surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269143 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

PB Rahmanian ◽

A Kröner ◽

G Langebartels ◽

T Wahlers

Keyword(s):

Body Mass Index ◽

Cardiac Surgery ◽

Postoperative Complications ◽

Hospital Mortality ◽

Body Mass ◽

Recent Cohort

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Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000534 ◽

2021 ◽

pp. svn-2020-000534

Author(s):

Zhentang Cao ◽

Xinmin Liu ◽

Zixiao Li ◽

Hongqiu Gu ◽

Yingyu Jiang ◽

...

Keyword(s):

Body Mass Index ◽

Hospital Mortality ◽

Body Mass ◽

Intracerebral Haemorrhage ◽

Final Analysis ◽

Normal Weight ◽

Discharge Disposition ◽

Increased Risk ◽

Significant Difference ◽

Stroke Center

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

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