A Better Predictor of Acute Kidney Injury After Cardiac Surgery: The Largest Area Under the Curve Below the Oxygen Delivery Threshold During Cardiopulmonary Bypass

Objective: to assess the relationship between oxygen delivery during cardiopulmonary bypass and the incidende of acute kidney injury in the immediate postoperative period of patients undergoing cardiac surgery, as well as to identify possible risk factors. Methods: A retrospective observational study of patients undergoing cardiac surgery scheduled between May 2016 and February 2018 was carried out in which the M-M4 System was used for online blood gases. Patients with preoperative diagnosis of chronic renal failure were excluded. For the oxigen delivery, the average of all M4 records was made. Results: 133 patients (35.3% women) with a mean age of 64.9 ± 10.9 years were studied. The incidence of acute kidney injury was 18.8% (AKI I: 12%; AKI II: 3%; AKI III: 3.8%). There was no correlation between acute kidney injury and O2 delivery (251 ± 43 vs 247 ± 52, ns), if there was a difference when patients needed renal replacement therapy (251 ± 43 vs 198 ± 18, p = 0.04). There was a significant increase risk in diabetes; HTA; pulmonary arterial hypertension; chronic atrial fibrilation; red blood cell concentrate and blood products administration in the operating room; redo for bleeding; high lactic acid and glycemia post cardiopulmonary bypass; prolonged pump and ischemia times; and combined surgery. Conclusions: There was no direct relationship between O2 delivery and acute kidney injury, although there was a significantly lower O2 delivery in patients who needed postoperative renal replacement therapy.

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Faculty Opinions recommendation of Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725330551.793503647 ◽

2015 ◽

Author(s):

Claudio Ronco ◽

Zaccaria Ricci

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Cardiopulmonary Bypass ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Case Control Study ◽

Kidney Injury ◽

Case Control ◽

Control Study

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Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload

Pediatric Nephrology ◽

10.1007/s00467-021-04976-2 ◽

2021 ◽

Author(s):

Dominic Zanaboni ◽

Jungwon Min ◽

Roopa Seshadri ◽

J. William Gaynor ◽

Molly Dreher ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Fluid Overload ◽

Kidney Injury

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Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in children after cardiac surgery

Paediatrica Indonesiana ◽

10.14238/pi56.4.2016.230-7 ◽

2016 ◽

Vol 56 (4) ◽

pp. 230

Author(s):

Meta Herdiana Hanindita ◽

Riskky Vitria Prasetyo ◽

Ninik Asmaningsih Soemyarso ◽

I Ketut Alit Utamayasa ◽

Paul Tahalele

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Creatinine Clearance ◽

Sensitivity And Specificity ◽

Area Under The Curve ◽

Kidney Injury ◽

Schwartz Formula ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

Neutrophil Gelatinase

Background Acute kidney injury (AKI) is still diagnosed by measuring the estimated creatinine clearance (eCCl), despite the fact that it may not change until 50% or more of kidney function has been lost. AKI after cardiac surgery is related to prolonged intensive care, decreased quality of life, and increased long term mortality. Neutrophil gelatinase-associated lipocalin (NGAL) represents an early biomarker of AKI, which may be useful for assessing AKI in cardiac patients.Objective To determine the validity of urinary and plasma NGAL as biomarkers for AKI in children after cardiac surgery.Methods Subjects were children who underwent cardiac surgery in Dr. Soetomo Hospital, Surabaya, Indonesia from August 2013 to January 2014. Serial urine and blood samples were analyzed for NGAL before surgery, as well as at 2h, 4h, 12h, and 24h after surgery. The AKI was established based on pRIFLE criteria. Estimated creatinine clearance (eCCl) was calculated from the estimated glomerular filtration rate (eGFR), according to age by the traditional Schwartz formula. Serum creatinine was assayed by the Jaffe method before surgery, as well as at 12h, 24h, 48h, and 72h after surgery.Results Of 20 subjects, 5 developed AKI. Urinary and plasma NGAL increased markedly at 2h postoperatively, as compared to eGFR which showed a rise at 12-48 h after cardiac surgery. Analysis of 2h post-operative urinary NGAL at a cut off value of 11.270ng/mL yielded an area under the curve (AUC) of 1.00 (95%CI 2.63 to 12.13), with sensitivity and specificity of 100% each for AKI. In addition, 2h post-operative plasma NGAL at a cut off value of 8.385 ng/mL yielded an AUC of 1.00 (95%CI 3.71 to 12.15) with sensitivity and specificity of 100% each for AKI.Conclusion Urinary and plasma NGAL are valid as early biomarkers for AKI in children after cardiac surgery.

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Time–dose response of oxygen delivery during cardiopulmonary bypass predicts acute kidney injury

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2018.10.148 ◽

2019 ◽

Vol 158 (2) ◽

pp. 492-499 ◽

Cited By ~ 7

Author(s):

Hiroshi Mukaida ◽

Satoshi Matsushita ◽

Kenji Kuwaki ◽

Takahiro Inotani ◽

Yuki Minami ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiopulmonary Bypass ◽

Dose Response ◽

Oxygen Delivery ◽

Kidney Injury ◽

Time Dose

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CIRP Secretion during Cardiopulmonary Bypass Is Associated with Increased Risk of Postoperative Acute Kidney Injury

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1730450 ◽

2021 ◽

Author(s):

Wenyan Liu ◽

Yang Yan ◽

Dan Han ◽

Yongxin Li ◽

Qian Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Rna Binding ◽

Multivariable Analysis ◽

Kidney Injury ◽

Proinflammatory Response ◽

Increased Risk ◽

Before And After ◽

The Difference

Abstract Background Systemic inflammation contributes to cardiac surgery–associated acute kidney injury (AKI). Cardiomyocytes and other organs experience hypothermia and hypoxia during cardiopulmonary bypass (CPB), which induces the secretion of cold-inducible RNA-binding protein (CIRP). Extracellular CIRP may induce a proinflammatory response. Materials and Methods The serum CIRP levels in 76 patients before and after cardiac surgery were determined to analyze the correlation between CIRP levels and CPB time. The risk factors for AKI after cardiac surgery and the in-hospital outcomes were also analyzed. Results The difference in the levels of CIRP (ΔCIRP) after and before surgery in patients who experienced cardioplegic arrest (CA) was 26-fold higher than those who did not, and 2.7-fold of those who experienced CPB without CA. The ΔCIRP levels were positively correlated with CPB time (r = 0.574, p < 0.001) and cross-clamp time (r = 0.54, p < 0.001). Multivariable analysis indicated that ΔCIRP (odds ratio: 1.003; 95% confidence interval: 1.000–1.006; p = 0.027) was an independent risk factor for postoperative AKI. Patients who underwent aortic dissection surgery had higher levels of CIRP and higher incidence of AKI than other patients. The incidence of AKI and duration of mechanical ventilation in patients whose serum CIRP levels more than 405 pg/mL were significantly higher than those less than 405 pg/mL (65.8 vs. 42.1%, p = 0.038; 23.1 ± 18.2 vs. 13.8 ± 9.2 hours, p = 0.007). Conclusion A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.

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Duration of critically low oxygen delivery is associated with acute kidney injury after cardiac surgery

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13457 ◽

2019 ◽

Vol 63 (10) ◽

pp. 1290-1297 ◽

Cited By ~ 1

Author(s):

Sebastian R. Rasmussen ◽

Kristian Kandler ◽

Rikke V. Nielsen ◽

Peter Cornelius Jakobsen ◽

Nikoline N. Knudsen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Delivery ◽

Kidney Injury ◽

Low Oxygen

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Clinical and Operative Determinants of Acute Kidney Injury after Cardiac Surgery

Cardiorenal Medicine ◽

10.1159/000507777 ◽

2020 ◽

Vol 10 (5) ◽

pp. 340-352

Author(s):

Faeq Husain-Syed ◽

Maria Giovanna Quattrone ◽

Fiorenza Ferrari ◽

Pércia Bezerra ◽

Salvador Lopez-Giacoman ◽

...

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Cardiac Surgery ◽

Minimally Invasive Surgery ◽

Cardiopulmonary Bypass ◽

Minimally Invasive ◽

Invasive Surgery ◽

Fluid Balance ◽

Kidney Injury ◽

Baseline Serum

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with increased morbidity and mortality. Objectives: We aimed to identify potentially modifiable risk factors for CSA-AKI. Methods: This was asingle-center retrospective cohort study of 495 adult patients undergoing cardiac surgery. AKI was diagnosed and staged using full KDIGO criteria incorporating baseline serum creatinine (SC) levels and correction of postoperative SC levels for fluid balance. We examined the association of routinely available clinical and laboratory data with AKI using multivariate logistic regression modeling. Results: A total of 103 (20.8%) patients developed AKI: 16 (15.5%) patients were diagnosed with AKI upon hospital admission, and 87 (84.5%) patients were diagnosed with CSA-AKI. Correction of SC levels for fluid balance increased the number of AKI cases to 104 (21.0%), with 6 patients categorized to different AKI stages. Univariate logistic regression analysis identified five preoperative (age, sex, diabetes mellitus, preoperative systolic pulmonary arterial pressure [PSPAP], acute decompensated heart failure) and five intraoperative predictors of AKI (age, sex, red blood cell [RBC] volume transfused, use of minimally invasive surgery, duration of cardiopulmonary bypass). When all preoperative and intraoperative variables were incorporated into one model, six predictors remained significant (age, sex, use of minimally invasive surgery, RBC volume transfused, PSPAP, duration of cardiopulmonary bypass). Model discrimination performance showed an area under the curve of 0.69 for the model including only preoperative variables, 0.76 for the model including only intraoperative variables, and 0.77 for the model including all preoperative and intraoperative variables. Conclusions: Use of minimally invasive surgery and therapies mitigating PSPAP and intraoperative blood loss may offer protection against CSA-AKI.

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