Haptoglobin and Free Haemoglobin during Cardiac Surgery—is there a Link to Acute Kidney Injury?

Acute kidney injury (AKI) is frequently observed after cardiac surgery (CS) with cardiopulmonary bypass (CPB). Multiple mechanisms underlie this phenomenon, including CPB-dependent haemolysis. Haemoglobin is released during haemolysis, and free haemoglobin (frHb) causes tubular cell injury after exceeding the binding capacity of haptoglobin (Hp). The objective of this study was to investigate the influence of perioperative changes in frHb and Hp levels on the incidence of CS-associated (CSA) AKI. After receiving local ethics committee approval and obtaining informed consent from our patients, we analysed the data pertaining to 154 patients undergoing CPB surgery. We recorded frHb and Hp concentrations pre-, intra- and postoperatively and defined AKI using the Kidney Disease Improving Global Outcomes (KDIGO) classification. We observed that frHb levels increased significantly during surgery and then decreased at ten hours thereafter and that Hp levels decreased during surgery and remained at low levels until the first postoperative day. We noted a moderate negative correlation between frHb and Hp levels. AKI was identified in 45.5% of patients; however, there was no significant difference in frHb or Hp levels between patients with and without AKI. We did not observe a relationship between frHb or Hp levels and CSA AKI and thus could not confirm the hypothesis that patients with higher baseline Hp concentrations experience a lower incidence of AKI than patients with lower baseline Hp concentrations.

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Preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in cardiac surgery patients

Medicinski pregled ◽

10.2298/mpns2002005g ◽

2020 ◽

Vol 73 (1-2) ◽

pp. 5-12

Author(s):

Miodrag Golubovic ◽

Andrej Preveden ◽

Ranko Zdravkovic ◽

Jelena Vidovic ◽

Bojan Mihajlovic ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Uric Acid ◽

Cardiac Surgery ◽

Kidney Injury ◽

C Reactive Protein ◽

Reactive Protein ◽

Preoperative Hemoglobin ◽

Significant Difference ◽

Acute Kidney Injury Development

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.

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Variation in clinical usefulness of biomarkers of acute kidney injury in young children undergoing cardiac surgery

Clinical and Experimental Pediatrics ◽

10.3345/cep.2019.00913 ◽

2020 ◽

Vol 63 (4) ◽

pp. 151-156

Author(s):

Hee Sun Baek ◽

Youngok Lee ◽

Hea Min Jang ◽

Joonyong Cho ◽

Myung Chul Hyun ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Young Children ◽

Serum Creatinine ◽

Congenital Heart ◽

Heart Diseases ◽

Kidney Injury ◽

Clinical Usefulness ◽

Congenital Heart Diseases ◽

Significant Difference

Background: Acute kidney injury (AKI) is one of the most significant postoperative complications of pediatric cardiac surgery. Because serum creatinine has limitations as a diagnostic marker of AKI, new biomarkers including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) are being evaluated to overcome these limitations and detect AKI at an early stage after cardiac surgery.Purpose: This study aimed to investigate the clinical usefulness of these biomarkers in young children.Methods: Thirty patients with congenital heart diseases who underwent cardiac surgery using cardiopulmonary bypass (CPB) were selected, and their urine and blood samples were collected at baseline and 6, 24, and 48 hours after surgery. Serum creatinine and blood urea nitrogen levels as well as NGAL, KIM-1, and IL-18 levels in urine samples were measured, and clinical parameters were evaluated.Results: Of the 30 patients, 12 developed AKI within 48 hours after cardiac surgery. In the AKI group, 8 of 12 (66.6%) met AKI criteria after 24 hours, and urine KIM-1/creatinine (Cr) level (with adjustment of urine creatinine) peaked at 24 hours with significant difference from baseline level. Additionally, urine KIM-1/Cr level in the AKI group was significantly higher than in the non-AKI group at 6 hours. However, urine NGAL/Cr and IL-18/Cr levels showed no specific trend with time for 48 hours after cardiac surgery.Conclusion: It is suggested that urine KIM-1/Cr concentration could be considered a good biomarker for early AKI prediction after open cardiac surgery using CPB in young children with congenital heart diseases.

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Serum klotho as a marker for early diagnosis of acute kidney injury after cardiac surgery

Journal of Medical Biochemistry ◽

10.2478/jomb-2019-0024 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Aleš Jerin ◽

Osama F Mosa ◽

Jurij M Kališnik ◽

Janez Žibert ◽

Milan Skitek

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Early Diagnosis ◽

Lower Risk ◽

Kidney Injury ◽

Tree Model ◽

Significant Difference ◽

Better Than

SummaryBackgroundEarly diagnosis of acute kidney injury (AKI) after cardiac surgery is based on serum creatinine which is neither a specific nor a sensitive biomarker. In our study, we investigated the role of serum Klotho in early prediction of AKI after cardiac surgery using cardiopulmonary bypass (CPB).MethodsThe included patients were classified into three groups according to AKI stages using KDIGO criteria. The measurements of creatinine and Klotho levels in serum were performed before surgery, at the end of CPB, 2 hours after the end of CPB, 24 hours and 48 hours postoperatively.ResultsSeventy-eight patients were included in the study. A significant increase of creatinine levels (p<0.001) was measured on the first day after the surgery in both AKI groups compared to the non-AKI group. However, a significant difference between AKI-2 and AKI-1 groups (p=0.006) was not measured until the second day after the operation. Using decision trees for classification of patients with a higher or lower risk of AKI we found out that Klotho discriminated between the patients at low risk of developing more severe kidney injury in the first hours after surgery and the patients at high risk better than creatinine. Adding also the early measurements of creatinine in the decision tree model further improved the prediction of AKI.ConclusionSerum Klotho may be useful to discriminate between the patients at lower and the patients at higher risk of developing severe kidney injury after cardiac surgery using CPB already in the first hours after surgery.

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Evaluation the preventive effect of Selenium on acute kidney injury following on-pump cardiac surgery

10.32592/ircmj.2021.23.9.377 ◽

2021 ◽

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Stress Responses ◽

Kidney Injury ◽

Control Group ◽

Double Blind ◽

Hospitalization Period ◽

Significant Difference ◽

Postoperative Stress ◽

And Control

Introduction: patients who undergo on-pump cardiac surgery are at risk of acute kidney injury following the operation. This is mainly due to some ischemic events and also pre- and postoperative stress responses which can result in postoperative organ dysfunction. Selenium as an antioxidant may help to reduce the inflammation and subsequent related complications. In this study we tested that if administration of oral Se compliment before and following the on-pump cardiac surgery can reduce the incidence or severity of kidney injury following the operation. Methods: In a randomized double-blind trial we divided the randomly selected patients who were candidate for on-pupm cardiac surgery into two groups of those who received selenium and control group. In selenium group we administrated 500 µg of selenium orally 14 and 2 hours before surgery and every 12 hours postoperatively for 2 days (overall 3000 µg) while the control group received only the routine and standard care. Subsequently patients were closely observed for serum creatinine rise and incidence of post-operative AKI during their hospitalization period in both groups using both Rifle and AKIN criteria separately. Besides, some additional data including: ICU-stay, duration of the operation and need for Blood products during the operation were recorded. At the end, the statistical analysis was carried out using SPSS 11.5 software in order to determine any significant difference in case and control group. Results: The study population included 120 patients divided in two equal groups of 60, consisting of 46 (38.3%) males and 74 (61.7%) females with the mean age of 52.8±16.7 years. Both groups were similar regarding the demographics and comorbidities. Also statistics showed no significant difference regarding Cardiac Operative Risk Evaluation (EuroSCORE) in both groups. Considering the RIFLR criteria, AKI occurred in 11 (17.9%) patients in selenium group and 13 (21.4%) patients in control group while based on AKIN criteria figures were 17 (28.6%) and 21 (35.7%) in selenium and the control group , respectively. The most frequent stage of AKI among patients was the first stage in both group and the highest rate of AKI occurred in 3-4 days after surgery in both groups. Conclusion: According to our research Administrating oral Selenium was not beneficial in order to prevent AKI after on-pump cardiac surgery.

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Does dexmedetomidine reduce the risk of acute kidney injury after cardiac surgery: a meta-analysis of randomized controlled trials

10.22541/au.163966482.25068289/v1 ◽

2021 ◽

Author(s):

Chunxiao Zhao ◽

Shuo Liu ◽

Huiquan Zhang ◽

Mengqi Gao

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Postoperative Mortality ◽

Kidney Injury ◽

Adult Patients ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference ◽

Postoperative Aki

OBJECTIVE: Acute kidney injury (AKI) is a common complication after cardiac surgery, and there is no pharmacologic prophylaxis of AKI. Some animal and clinical studies showed the renoprotection effect of dexmedetomidine (DEX) on AKI, but data from other trials came to the opposite conclusion following cardiac surgery. METHODS: We searched databases including EMBASE, PubMed, and Cochrane CENTRAL for randomized controlled trials (RCTs) focused on DEX for AKI in adult patients after cardiac surgery. The primary outcome was incidence of AKI. Secondary outcomes were mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay (LOS), hospital LOS and mortality. RESULTS: Fifteen trials enrolling 2907 study patients were collected in the meta-analyses. Compared with controls, DEX reduced the incidence of postoperative AKI [odds ratio (OR), 0.66; 95%confidence interval (CI), 0.48-0.91; P=0.01], and there was no significant difference between groups in postoperative mortality (OR, 0.63; 95%CI, 0.32-1.26; P=0.19), MV duration [weighted mean difference(WMD), -0.44; 95%CI, -1.50-0.63; P=0.42], ICU LOS (WMD, -1.19; 95%CI, -2.89-0.51; P=0.17) and hospital LOS (WMD, -0.31; 95%CI, -0.76-0.15; P=0.19). CONCLUSIONS: Perioperative DEX use reduced the incidence of postoperative AKI in adult patients undergoing cardiac surgery. No significant decrease existed in mortality, MV duration, ICU LOS and hospital LOS owing to the DEX administration.

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Investigating the Effect of Near Infra-red Spectroscopy (NIRS) on Early Diagnosis of Cardiac Surgery Associated Acute Kidney Injury

10.21203/rs.3.rs-78250/v1 ◽

2020 ◽

Author(s):

Fatemeh Javaherforoosh zadeh ◽

Hojatolah Bhandori ◽

Sara Jarirahmadi ◽

Nima Bakhtiari

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Single Point ◽

Kidney Tissue ◽

Kidney Injury ◽

Major Complication ◽

Repeated Measurement ◽

Tissue Oxygen Saturation ◽

Operative Care ◽

Significant Difference

Abstract Background. Cardiac surgery-associated acute kidney injury (CSA –AKI), is a major complication of cardiac surgery. Early detection of this complication can improve the quality of post-operative care and help to prevent this phenomenon.Materials and Methods: 148 patients were enrolled to study and 107 patients were selected for analysis between February and September 2019 in the cardiac surgery unit of Golestan Hospital. Ahvaz. Iran. Kidney tissue oxygen saturation was measured in multiple definite times during surgery. Hemoglobin, blood urea nitrogen, creatinine, and lactate were measured during and 48 hours after surgery.Results: Forty-one patients were diagnosed of CSA-AKI according to KDIGO criteria. Parametric and non-parametric analyzes significant difference was not detected between CSA-AKI and NON CSA-AKI group in the demographic parameter. Repeated measurement of ANOVA Analysis did not show any significant difference in parameters except for BUN. Repeated measurement of ANOVA showed a significant difference in both groups and time factors (p<0.001, p=0.0006 respectively). ROC curve analyzes showed in a single point of time, difference the middle of CPB time from baseline high-value in the prediction of AKI 0.764 (0.57 to 0.951) (AUC-CI). Conclusion; Kidney saturation monitoring could be considered as routine monitoring in cardiac surgery for the rapid detection of CSA -AKI. Although kidney tissue saturation is not correlated directly to the arterial saturation of oxygen, physician and surgery team could predict the chance of acute kidney injury exposure.

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Risk factors for acute kidney injury in postoperative cardiac surgery

Research Society and Development ◽

10.33448/rsd-v10i2.12480 ◽

2021 ◽

Vol 10 (2) ◽

pp. e34710212480

Author(s):

Mario Augusto Cray da Costa ◽

Stella Kuchller ◽

Vanessa Carolina Botta ◽

Adriana de Fátima Menegat Schuinski ◽

Ana Carolina Mello Fontoura de Souza

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Function ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Body Mass ◽

Kidney Injury ◽

Male Gender ◽

Baseline Serum ◽

Significant Difference

Objective: To evaluate the perioperative risk factors associated with postoperative AKI in patients undergoing cardiac surgery. Methodology: Between January 2011 and December 2017, we analyzed prospectively 544 patients, who were divided into two groups: patients with acute kidney injury associated with cardiac surgery (AKI-ACS) defined as an increase of 0.3 mg/dL or 1.5 times the baseline serum creatinine value and control group formed by patients without AKI-ACS. We compared patients and surgical variables using the chi-square test, Fisher's exact test, and mann-Whitney test and logistic regression. Results: AKI-ACS occurred in 29.8% of the patients. In the univariate analysis, the following variables presented a statistically significant difference: male gender (p=0.0087), age (p<0.0001), body mass (p=0.035), BMI (p=0.001), thoracic aortic surgery (p=0.029), use of extracorporeal circulation (p=0.012), CPB time (p=0.0001), aortic clamping time (p=0.0029), use of vasoactive drugs in post-operative period (p=0.017), preoperative kidney function (p<0.0001), presence of diabetes mellitus (p=0.008) and NYHA functional class (p=0.041). In the multivariate analysis, the following variables presented a statistical difference: male gender (OR 2.11), higher BMI (OR 2.11), worse preoperative renal function, demonstrated by creatinine clearance (OR 0.13), longer cardiopulmonary bypass (OR 1.008). Conclusion: The independent predictors for LRA-ACC were male gender, higher body mass index, worse preoperative renal function, and more complex surgeries associated with longer cardiopulmonary bypass.

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Teprasiran, A Small Interfering RNA, for the Prevention of Acute Kidney Injury in High-Risk Patients Undergoing Cardiac Surgery: A Randomized Clinical Study

Circulation ◽

10.1161/circulationaha.120.053029 ◽

2021 ◽

Author(s):

Matthias Thielmann ◽

David Corteville ◽

Gabor Szabo ◽

Madhav Swaminathan ◽

Andre Lamy ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

High Risk ◽

Small Interfering Rna ◽

Kidney Injury ◽

High Risk Patients ◽

Randomized Clinical Study ◽

Significant Difference ◽

Risk Patients ◽

Interfering Rna

Background: Acute kidney injury (AKI) affects up to 30% of cardiac surgery patients, leading to increased in-hospital and long-term morbidity and mortality. Teprasiran is a novel small interfering RNA (siRNA) that temporarily inhibits p53-mediated cell death, which underlies AKI. Methods: This prospective, multicenter, double-blind, randomized, controlled Phase 2 trial evaluated the efficacy and safety of a single 10 mg/kg dose of teprasiran vs. placebo (1:1), in reducing the incidence, severity, and duration of AKI following cardiac surgery in high-risk patients. The primary endpoint was proportion of patients who developed AKI determined by serum creatinine (sCr) by post-operative day 5. Other endpoints included AKI severity and duration using various prespecified criteria. To inform future clinical development, a composite endpoint of major adverse kidney events at day 90 (MAKE90), including death, renal replacement therapy (RRT) and ≥25% reduction of estimated glomerular filtration rate (eGFR) was assessed. Both sCr and serum cystatin-C (sCys) were used for eGFR assessments. Results: A total of 360 patients were randomized in 41 centers. 341 dosed patients were 73±7.5 years old (mean±SD), 72% were male, and median Euroscore-II (European System for Cardiac Operative Risk Evaluation) was 2.6%. Demographics and surgical parameters were similar between groups. AKI incidence was 37% for teprasiran vs. 50% for placebo-treated patients, a 12.8% absolute risk reduction (ARR), p=0.02; OR=0.58 (95% CI 0.37 to 0.92). AKI severity and duration were also improved with teprasiran: 2.5% of teprasiran vs. 6.7% of placebo-treated patients had Grade 3 AKI; 7% teprasiran vs. 13% placebo-treated patients had AKI lasting for 5 days. No significant difference was observed for the MAKE90 composite in the overall population. No safety issues were identified with teprasiran treatment. Conclusions: The incidence, severity, and duration of early AKI in high-risk patients undergoing cardiac surgery were significantly reduced following teprasiran administration. A Phase 3 study with a MAKE90 primary outcome which has recently completed enrollment was designed based on these findings (NCT03510897). Clinical Trial Registration: URL: https://clinicaltrials.gov/ Unique Identifier: NCT02610283

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Investigating the Effect of Near Infra-Red Spectroscopy (NIRS) on Early Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury

Anesthesiology and Pain Medicine ◽

10.5812/aapm.109863 ◽

2020 ◽

Vol 10 (6) ◽

Author(s):

Fatemeh Javaherforooshzadeh ◽

Hojatolah Bhandori ◽

Sara Jarirahmadi ◽

Nima Bakhtiari

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Repeated Measures ◽

Arterial Oxygen Saturation ◽

Kidney Tissue ◽

Kidney Injury ◽

Arterial Oxygen ◽

Repeated Measures Anova ◽

Significant Difference

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major adverse effect of cardiac surgery. The early detection of this complication can improve the quality of postoperative care and help prevent this phenomenon. Methods: In this prospective descriptive-analytical study, 148 patients were enrolled, 107 of whom were selected for analysis between February and September 2019 in the Cardiac Surgery Unit of Golestan Hospital, Ahvaz, Iran. Kidney tissue oxygen saturation was measured at multiple definite times during surgery. Hemoglobin, blood urea nitrogen, creatinine, and lactate were measured during and 48 hours after the surgery. Results: Forty-one patients were diagnosed with CSA-AKI according to the KDIGO criteria. Parametric and non-parametric analyses showed no significant difference between the CSA-AKI and non-CSA-AKI groups in the demographic parameters. Repeated measures ANOVA showed no significant difference in parameters, except for BUN. Repeated measures ANOVA showed a significant difference between both groups and time factors (P < 0.001, P = 0.0006, respectively). The ROC curve analyses showed that in a single point of time, the difference in the middle of CPB time from baseline had a high value in the prediction of AKI (AUC: 0.764; CI: 0.57 - 0.951). Conclusions: Kidney saturation monitoring could be considered in cardiac surgery for the rapid detection of CSA-AKI. Although kidney tissue saturation is not correlated directly to the arterial oxygen saturation, the physician and the surgery team can predict the chance of acute kidney injury.

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