scholarly journals The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuki Kotani ◽  
Takuo Yoshida ◽  
Junji Kumasawa ◽  
Jun Kamei ◽  
Akihisa Taguchi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Venous Pressure ◽  
Weighted Average ◽  
Kidney Injury ◽  
Blood Pressure Target ◽  
Hemodynamic Parameters ◽  
Percentage Difference ◽  
Time Weighted Average ◽  
The Impact

Abstract Background Cardiac surgery is performed worldwide, and acute kidney injury (AKI) following cardiac surgery is a risk factor for mortality. However, the optimal blood pressure target to prevent AKI after cardiac surgery remains unclear. We aimed to investigate whether relative hypotension and other hemodynamic parameters after cardiac surgery are associated with subsequent AKI progression. Methods We retrospectively enrolled adult patients admitted to 14 intensive care units after elective cardiac surgery between January and December 2018. We defined mean perfusion pressure (MPP) as the difference between mean arterial pressure (MAP) and central venous pressure (CVP). The main exposure variables were time-weighted-average MPP-deficit (i.e., the percentage difference between preoperative and postoperative MPP) and time spent with MPP-deficit > 20% within the first 24 h. We defined other pressure-related hemodynamic parameters during the initial 24 h as exploratory exposure variables. The primary outcome was AKI progression, defined as one or more AKI stages using Kidney Disease: Improving Global Outcomes’ creatinine and urine output criteria between 24 and 72 h. We used multivariable logistic regression analyses to assess the association between the exposure variables and AKI progression. Results Among the 746 patients enrolled, the median time-weighted-average MPP-deficit was 20% [interquartile range (IQR): 10–27%], and the median duration with MPP-deficit > 20% was 12 h (IQR: 3–20 h). One-hundred-and-twenty patients (16.1%) experienced AKI progression. In the multivariable analyses, time-weighted-average MPP-deficit or time spent with MPP-deficit > 20% was not associated with AKI progression [odds ratio (OR): 1.01, 95% confidence interval (95% CI): 0.99–1.03]. Likewise, time spent with MPP-deficit > 20% was not associated with AKI progression (OR: 1.01, 95% CI 0.99–1.04). Among exploratory exposure variables, time-weighted-average CVP, time-weighted-average MPP, and time spent with MPP < 60 mmHg were associated with AKI progression (OR: 1.12, 95% CI 1.05–1.20; OR: 0.97, 95% CI 0.94–0.99; OR: 1.03, 95% CI 1.00–1.06, respectively). Conclusions Although higher CVP and lower MPP were associated with AKI progression, relative hypotension was not associated with AKI progression in patients after cardiac surgery. However, these findings were based on exploratory investigation, and further studies for validating them are required. Trial Registration UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm, UMIN000037074.

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis

2019 ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Mean Arterial Pressure ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods A retrospective study was performed in patients underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the following perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injury: mean arterial pressure, mean perfusion pressure, central venous pressure, and diastolic perfusion pressure. Multivariate regression analysis was conducted to identify the independent hemodynamic predictors for the development of acute kidney injury. Subgroup analysis was further performed in patients with chronic hypertension. Results Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: a retrospective analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Chronic Hypertension ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods A retrospective study was performed in patients who underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injury to identify the independent hemodynamic predictors for acute kidney injury. Subgroup analysis was further performed in patients with chronic hypertension. Results Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects (n = 91) showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis

2019 ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Chronic Hypertension ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background:We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods:A retrospective study was performed in patients who underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injuryto identify the independent hemodynamic predictors for acute kidney injury.Subgroup analysis was further performed in patients with chronic hypertension. Results:Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P= 0.045). Subgroup analyses in hypertensive subjects (n = 91)showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P= 0.033; peak central venous pressure, odds ratio 1.328, P= 0.010, respectively). Conclusions:Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis

2019 ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Chronic Hypertension ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background: We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods: A retrospective study was performed in patients who underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injuryto identify the independent hemodynamic predictors for acute kidney injury.Subgroup analysis was further performed in patients with chronic hypertension. Results: Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects ( n = 91)showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions: Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

scholarly journals Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

2020 ◽  
Author(s):  
Benedict Morath ◽  
Andreas Meid ◽  
Johannes Rickmann ◽  
Jasmin Soethoff ◽  
Markus Verch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Kidney Function ◽  
Hydroxyethyl Starch ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Retrospective Cohort Analysis ◽  
The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

scholarly journals Impact of Early versus Late Initiation of Renal Replacement Therapy in Patients with Cardiac Surgery-Associated Acute Kidney Injury: Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials

2018 ◽  
Vol 2018 ◽  
pp. 1-13
Author(s):  
Jie Cui ◽  
Da Tang ◽  
Zhen Chen ◽  
Genglong Liu
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Early Initiation ◽  
Trial Sequential Analysis ◽  
Initiation Time ◽  
Late Initiation ◽  
The Impact

Background. Previous studies have examined the effect of the initiation time of renal replacement therapy (RRT) in patients with cardiac surgery-associated acute kidney injury (CSA-AKI), but the findings remain controversial. The aim of this meta-analysis was to systematically and quantitatively compare the impact of early versus late initiation of RRT on the outcome of patients with CSA-AKI.Methods. Four databases (PubMed, the Cochrane Library, ISI Web of Knowledge, and Embase) were systematically searched from inception to June 2018 for randomized clinical trials (RCTs). Two investigators independently performed the literature search, study selection, data extraction, and quality evaluation. Meta-analysis and trial sequential analysis (TSA) were used to examine the impact of RRT initiation time on all-cause mortality (primary outcome). The Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the level of evidence.Results. We identified 4 RCTs with 355 patients that were eligible for inclusion. Pooled analyses indicated no difference in mortality for patients receiving early and late initiation of RRT (relative risk [RR] = 0.61, 95% confidence interval [CI] = 0.33 to 1.12). However, the results were not confirmed by TSA. Similarly, early RRT did not reduce the length of stay (LOS) in the intensive care unit (ICU) (mean difference [MD] = -1.04; 95% CI = -3.34 to 1.27) or the LOS in the hospital (MD = -1.57; 95% CI = -4.62 to 1.48). Analysis using GRADE indicated the certainty of the body of evidence was very low for a benefit from early initiation of RRT.Conclusion. Early initiation of RRT had no beneficial impacts on outcomes in patients with CSA-AKI. Future larger and more adequately powered prospective RCTs are needed to verify the benefit of reduced mortality associated with early initiation of RRT.Trial Registration. This trial is registered with PROSPERO registration number CRD42018084465, registered on 11 February 2018.

scholarly journals Comparison of predication of Acute Kidney Injury after cardiac surgery by health care providers versus the biomarker [TIMP-2]*[IGFBP7] and scoring systems. Protocol for a prospective single center observational study (PREDICTAKI)

2020 ◽  
Author(s):  
Wim Vandenberghe ◽  
Lien Van Laethem ◽  
Alexander Zarbock ◽  
Melanie Meersch ◽  
Eric A.J. Hoste
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Healthcare Providers ◽  
Kidney Injury ◽  
List Type ◽  
Care Providers ◽  
Single Center ◽  
Single Center Study ◽  
The Impact ◽  
Center Study

AbstractIntroductionAcute kidney injury occurs in up to one third of patients after cardiac surgery and is an important contributor for adverse outcome. Previous research has demonstrated the benefit of a bundle of preventive measurements to reduce AKI in a subgroup of patients with high risk for AKI development. Urinary stress biomarkers [TIMP-2]*[IGFBP7] are used to identify these patients who are at risk for AKI. The trial aims to investigate the potential discrepancy between biomarker results and clinical estimation of occurrence of AKI on ICU in clinical practice.Methods and analysisWe plan to include 100 adult patients after cardiac surgery with cardiopulmonary bypass in a prospective, single center clinical trial. After cardiac surgery, different type of healthcare professional in ICU will provide a prediction of AKI occurrence and severity in the next 48 hours by filling in a questionnaire just before and after [TIMP-2]*[IGFBP7] biomarker analysis. Primary, this trial investigates the potential discrepancy in AKI prediction between clinical estimation by healthcare providers, biomarker results, and previous described score systems. Secondly, the impact of knowledge of the biomarker result on the quality of prediction by healthcare providers will be evaluated.Ethics and disseminationThis prospective, single center study has been approved by the medical ethical committee of the Ghent University Hospital (28th May 2019, trial registration number B670201939991). Informed consent was obtained for patients and healthcare providers.Summary strength and limitations-Influence of knowledge of a kidney biomarker on healthcare providers’ assessment of risk for AKI in clinical setting-Different types of healthcare providers with various expertise-It is a single center study with limited number of patients

scholarly journals High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality

2021 ◽  
Vol 10 (17) ◽  
pp. 3945
Author(s):  
Fridtjof Schiefenhövel ◽  
Ralf F. Trauzeddel ◽  
Michael Sander ◽  
Matthias Heringlake ◽  
Heinrich V. Groesdonk ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Central Venous ◽  
Icu Mortality ◽  
Roc Curve Analysis ◽  
Hemodynamic Deterioration ◽  
The Impact

Background: Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality. Methods: All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression. Results: ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent. Conclusions: A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.

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