Large volume infusions of hydroxyethyl starch during cardiothoracic surgery may be associated with postoperative kidney injury: propensity-matched analysis

Abstract Background The safety of intraoperative administration of hydroxyethyl starch (HES) has been debated. We hypothesized that intraoperative use of HES is associated with postoperative acute kidney injury (AKI) following cardiopulmonary bypass (CPB). Materials and methods Patients who underwent cardiothoracic surgery using CPB between 2007 and 2014 were retrospectively reviewed. The incidence of AKI within 7 days after surgery, defined by the Kidney Disease Improving Global Outcome criteria, was compared for patients who did or did not receive 6% (70/0.5) or 6% (130/0.4) HES for anesthesia management before or after CPB. Multivariable logistic regression and propensity matching analysis were performed to examine whether use of HES is associated with postoperative AKI. Outcomes comparing patients receiving HES ≥ 1000 mL and < 1000 mL were also compared. Results Data from 1976 patients were reviewed. All patients received 70/0.5 HES as a part of the priming solution for CPB. The incidence of postoperative AKI was 28.2% in patients who received HES and 26.0% in patients who did not (p = 0.33). In multivariable analysis, there was no correlation between the use of HES and the incidence of AKI (odds ratio 0.87, 95% CI 0.30–2.58, p = 0.81). Propensity matching showed that the incidence of AKI was not significantly different between 481 patients administered with HES and 962 patients (26.6% vs. 26.9%, p = 0.95) who did not receive HES for anesthesia management. However, peak creatinine levels, needed for renal replacement therapy, and in-hospital mortality were higher, and 28-day hospital-free days were lower in patients receiving HES ≥ 1000 mL than those receiving HES < 1000 mL (p < 0.05). Conclusions Intraoperative use of HES was not associated with postoperative AKI following CPB. However, administration of large volumes of HES may be associated with kidney-related adverse clinical outcomes.

Download Full-text

Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery

Anesthesiology ◽

10.1097/aln.0000000000000959 ◽

2016 ◽

Vol 124 (2) ◽

pp. 339-352 ◽

Cited By ~ 43

Author(s):

Miklos D. Kertai ◽

Shan Zhou ◽

Jörn A. Karhausen ◽

Mary Cooter ◽

Edmund Jooste ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Odds Ratio ◽

Artery Bypass ◽

Kidney Injury ◽

Bypass Grafting ◽

Cabg Surgery ◽

Platelet Counts ◽

Postoperative Aki

Abstract Background Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperative nadir platelet counts are associated with acute kidney injury (AKI) and mortality after coronary artery bypass grafting (CABG) surgery. Methods The authors evaluated 4,217 adult patients who underwent CABG surgery. Postoperative nadir platelet counts were defined as the lowest in-hospital values and were used as a continuous predictor of postoperative AKI and mortality. Nadir values in the lowest 10th percentile were also used as a categorical predictor. Multivariable logistic regression and Cox proportional hazard models examined the association between postoperative platelet counts, postoperative AKI, and mortality. Results The median postoperative nadir platelet count was 121 × 109/l. The incidence of postoperative AKI was 54%, including 9.5% (215 patients) and 3.4% (76 patients) who experienced stages II and III AKI, respectively. For every 30 × 109/l decrease in platelet counts, the risk for postoperative AKI increased by 14% (adjusted odds ratio, 1.14; 95% CI, 1.09 to 1.20; P < 0.0001). Patients with platelet counts in the lowest 10th percentile were three times more likely to progress to a higher severity of postoperative AKI (adjusted proportional odds ratio, 3.04; 95% CI, 2.26 to 4.07; P < 0.0001) and had associated increased risk for mortality immediately after surgery (adjusted hazard ratio, 5.46; 95% CI, 3.79 to 7.89; P < 0.0001). Conclusion The authors found a significant association between postoperative nadir platelet counts and AKI and short-term mortality after CABG surgery.

Download Full-text

Perioperative ABO Blood Group Isoagglutinin Titer and the Risk of Acute Kidney Injury after ABO-Incompatible Living Donor Liver Transplantation

Journal of Clinical Medicine ◽

10.3390/jcm10081679 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1679

Author(s):

Hyeyeon Cho ◽

Jinyoung Bae ◽

Hyun-Kyu Yoon ◽

Ho-Jin Lee ◽

Seong-Mi Yang ◽

...

Keyword(s):

Liver Transplantation ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Confidence Interval ◽

Odds Ratio ◽

Kidney Injury ◽

Multivariable Logistic Regression Analysis ◽

Ig G ◽

Postoperative Aki

For ABO-incompatible liver transplantation (ABO-i LT), therapeutic plasma exchange (TPE) is performed preoperatively to reduce the isoagglutinin titer of anti-ABO blood type antibodies. We evaluated whether perioperative high isoagglutinin titer is associated with postoperative risk of acute kidney injury (AKI). In 130 cases of ABO-i LT, we collected immunoglobulin (Ig) G and Ig M isoagglutinin titers of baseline, pre-LT, and postoperative peak values. These values were compared between the patients with and without postoperative AKI. Multivariable logistic regression analysis was used to evaluate the association between perioperative isoagglutinin titers and postoperative AKI. Clinical and graft-related outcomes were compared between high and low baseline and postoperative peak isoagglutinin groups. The incidence of AKI was 42.3%. Preoperative baseline and postoperative peak isoagglutinin titers of both Ig M and Ig G were significantly higher in the patients with AKI than those without AKI. Multivariable logistic regression analysis showed that preoperative baseline and postoperative peak Ig M isoagglutinin titers were significantly associated with the risk of AKI (baseline: odds ratio 1.06, 95% confidence interval 1.02 to 1.09; postoperative peak: odds ratio 1.08, 95% confidence interval 1.04 to 1.13). Cubic spline function curves show a positive relationship between the baseline and postoperative peak isoagglutinin titers and the risk of AKI. Clinical outcomes other than AKI were not significantly different according to the baseline and postoperative peak isoagglutinin titers. Preoperative high initial and postoperative peak Ig M isoagglutinin titers were significantly associated with the development of AKI. As the causal relationship between high isoagglutinin titers and risk of AKI is unclear, the high baseline and postoperative isoagglutinin titers could be used simply as a warning sign for the risk of AKI after liver transplantation.

Download Full-text

Association between recovered acute kidney injury within 48hours and mortality in patients following coronary angiography: a cohort study

European Heart Journal ◽

10.1093/eurheartj/ehab724.2154 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Q Li ◽

S Q Chen ◽

H Z Huang ◽

L W Liu ◽

W H Chen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Angiography ◽

Odds Ratio ◽

Baseline Level ◽

Primary Outcome ◽

Multivariable Analysis ◽

Kidney Injury ◽

Funding Sources ◽

All Cause Mortality ◽

The Impact

Abstract Background The association of recovered acute kidney injury (AKI) with mortality was controversial. Our study aims to investigate the impact of recovered AKI on mortality in patients following coronary angiography (CAG). Methods Our study retrospectively enrolled 3,970 patients with pre-operative serum p creatinine (Scr) and twice measurements within 48hours after procedure. Recovered AKI defined as the diagnosis of AKI (Scr >0.3 mg/dL or >50% from the baseline level) on day 1 when Scr failed to meet the criteria for AKI on the day 2. Maintained AKI was defined as AKI not meeting the definition for recovered AKI. The primary outcome was 1-year all-cause mortality. Multivariable logistic regression was used to assess the association between recovered AKI and 1-year mortality. Results Among 3,970 participants, 861 (21.7%) occurred AKI, of whom 128 (14.9%) was recovered AKI and 733 (85.1%) was maintained AKI. 312 (7.9%) patients died within 1-year after admission. After multivariable analysis, recovered AKI was not associated with higher 1-year mortality (adjusted odds ratio [aOR], 1.37; CI, 0.68–2.51) compared without AKI. Among AKI patients, Recovered AKI was associated with a 52% lower 1-year mortality compared with maintained AKI. Additionally, maintained AKI was significantly associated with higher 1-year mortality (aOR, 2.67; CI, 2.05–3.47). Conclusions Our data suggested that recovered AKI within 48h was a common subtype of AKI following CAG, without increasing mortality. More attention need to be paid to the patients suffering from maintained AKI following CAG. FUNDunding Acknowledgement Type of funding sources: None. Association of AKI and mortality Subgroups analysis

Download Full-text

Elevated preoperative D-dimer is associated with acute kidney injury after non-cardiac surgery

10.21203/rs.3.rs-271385/v1 ◽

2021 ◽

Author(s):

Yan Zhou ◽

Hong-Yun Yang

Keyword(s):

Cardiac Surgery ◽

Propensity Score ◽

Odds Ratio ◽

Additive Model ◽

Kidney Injury ◽

P Value ◽

Propensity Score Weighting ◽

Before And After ◽

Postoperative Aki ◽

D Dimer

Abstract aimed to analyze the relationship between preoperative D-dimer level and AKI following non-cardiac surgery.Method: This was a single-center retrospective cohort study for elective non-cardiac surgery from January 1, 2012, to December 31, 2018. The endpoint was the occurrence of AKI 7 days postoperatively in the hospital. The non-linear relationship was described using the generalized additive model. ROC and minimum P-value approach identified possible cut-off points. D-dimer's odds ratio as continuous, quantile, and dichotomous variables by various cut-off points for postoperative AKI were calculated in multivariate logistic regression models before and after propensity score weighting.Results: Of the 55439 surgery, 5.0% (2779 cases) suffered postoperative AKI. Non-linearity was found between D-dimer and postoperative AKI. The odds ratio for D-dimer before and after propensity score weighting was (≤ 0.380 µg/mL as reference, minimum P-value cut-off point) 1.35 (1.20-1.49), P < 0.001 and 1.25 (1.09-1.43), P = 0.001, respectively; (≤ 0.165 µg/mL as reference, ROC cut-off point) 1.24 (1.12-1.37), P < 0.001 and 1.18 (1.06-1.31), P = 0.002, respectively. Sensitivity analysis showed similar results. Heterogeneity subgroup analysis showed that patients with normal preoperative creatinine, hemoglobin level, and intraperitoneal surgery or more complex surgery seemed to be more vulnerable to elevated D-dimer.Conclusions: Preoperative D-dimer was significantly associated with postoperative AKI following non-cardiac surgery. The optimal cut-off point for preoperative D-dimer was 0.165 µg/mL by ROC approach and 0.38 µg/mL by minimum P-value approach.

Download Full-text

Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000000765 ◽

2015 ◽

Vol 123 (3) ◽

pp. 515-523 ◽

Cited By ~ 246

Author(s):

Louise Y. Sun ◽

Duminda N. Wijeysundera ◽

Gordon A. Tait ◽

W. Scott Beattie

Keyword(s):

Acute Kidney Injury ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Primary Outcome ◽

Kidney Injury ◽

Noncardiac Surgery ◽

Intraoperative Hypotension ◽

Outcome Relationship ◽

Surgical Duration ◽

Postoperative Aki

Abstract Background: Intraoperative hypotension (IOH) may be associated with postoperative acute kidney injury (AKI), but the duration of hypotension for triggering harm is unclear. The authors investigated the association between varying periods of IOH with mean arterial pressure (MAP) less than 55, less than 60, and less than 65 mmHg with AKI. Methods: The authors conducted a retrospective cohort study of 5,127 patients undergoing noncardiac surgery (2009 to 2012) with invasive MAP monitoring and length of stay of 1 or more days. Exclusion criteria were preoperative MAP less than 65 mmHg, dialysis dependence, urologic surgery, and surgical duration less than 30 min. The primary exposure was IOH. The primary outcome was AKI (50% or 0.3 mg/dl increase in creatinine) during the first 2 postoperative days. Multivariable logistic regression was used to model the exposure–outcome relationship. Results: AKI occurred in 324 (6.3%) patients and was associated with MAP less than 60 mmHg for 11 to 20 min and MAP less than 55 mmHg for more than 10 min in a graded fashion. The adjusted odds ratio of AKI for MAP less than 55 mmHg was 2.34 (1.35 to 4.05) for 11- to 20-min exposure and 3.53 (1.51 to 8.25) for more than 20 min. For MAP less than 60 mmHg, the adjusted odds ratio for AKI was 1.84 (1.11 to 3.06) for 11- to 20-min exposure. Conclusions: In this analysis, postoperative AKI is associated with sustained intraoperative periods of MAP less than 55 and less than 60 mmHg. This study provides an impetus for clinical trials to determine whether interventions that promptly treat IOH and are tailored to individual patient physiology could help reduce the risk of AKI.

Download Full-text

Intraoperative Arterial Pressure Variability and Postoperative Acute Kidney Injury

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.06620619 ◽

2019 ◽

Vol 15 (1) ◽

pp. 35-46 ◽

Cited By ~ 1

Author(s):

Sehoon Park ◽

Hyung-Chul Lee ◽

Chul-Woo Jung ◽

Yunhee Choi ◽

Hyung Jin Yoon ◽

...

Keyword(s):

Arterial Pressure ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Validation Cohort ◽

Kidney Injury ◽

Noncardiac Surgery ◽

Discovery Cohort ◽

Intraoperative Hypotension ◽

Average Real Variability ◽

Postoperative Aki

Background and objectivesHigh BP variability may cause AKI because of inappropriate kidney perfusion. This study aimed to investigate the association between intraoperative BP variability and postoperative AKI in patients who underwent noncardiac surgery.Design, setting, participants, & measurementsWe performed a cohort study of adults undergoing noncardiac surgery in hospitals in South Korea. We studied three cohorts using the following recording windows for intraoperative BP: discovery cohort, 1-minute intervals; first validation cohort, 5-minute intervals; and second validation cohort, 2-second intervals. We calculated four variability parameters (SD, coefficient of variation, variation independent of mean, and average real variability) based on the measured mean arterial pressure values. The primary outcomes were postoperative AKI (defined by the Kidney Disease Improving Global Outcomes serum creatinine cutoffs) and critical AKI (consisting of stage 2 or higher AKI and post-AKI death or dialysis within 90 days).ResultsIn the three cohorts, 45,520, 29,704, and 7435 patients were analyzed, each with 2230 (443 critical), 1552 (444 critical), and 300 (91 critical) postoperative AKI events, respectively. In the discovery cohort, all variability parameters were significantly associated with risk of AKI, even after adjusting for intraoperative hypotension. For example, average real variability was associated with higher risks of postoperative AKI (adjusted odds ratio, 1.13 per 1 SD increment; 95% CI, 1.07 to 1.19) and critical AKI (adjusted odds ratio, 1.13 per 1 SD increment; 95% CI, 1.02 to 1.26). Associations were evident predominantly among patients who also experienced intraoperative hypotension. In the validation analysis with 5-minute-interval BP records, all four variability parameters were associated with the risk of postoperative AKI or critical AKI. In the validation cohort with 2-second-interval BP records, average real variability was the only significant variability parameter.ConclusionsHigher intraoperative BP variability is associated with higher risks of postoperative AKI after noncardiac surgery, independent of hypotension and other clinical characteristics.

Download Full-text

Deep-learning-based real-time prediction of acute kidney injury outperforms human predictive performance

npj Digital Medicine ◽

10.1038/s41746-020-00346-8 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Nina Rank ◽

Boris Pfahringer ◽

Jörg Kempfert ◽

Christof Stamm ◽

Titus Kühne ◽

...

Keyword(s):

Acute Kidney Injury ◽

Deep Learning ◽

Real Time ◽

Kidney Injury ◽

Major Complication ◽

Predictive Performance ◽

Cardiothoracic Surgery ◽

Time Prediction ◽

Independent Test ◽

Postoperative Aki

Abstract Acute kidney injury (AKI) is a major complication after cardiothoracic surgery. Early prediction of AKI could prompt preventive measures, but is challenging in the clinical routine. One important reason is that the amount of postoperative data is too massive and too high-dimensional to be effectively processed by the human operator. We therefore sought to develop a deep-learning-based algorithm that is able to predict postoperative AKI prior to the onset of symptoms and complications. Based on 96 routinely collected parameters we built a recurrent neural network (RNN) for real-time prediction of AKI after cardiothoracic surgery. From the data of 15,564 admissions we constructed a balanced training set (2224 admissions) for the development of the RNN. The model was then evaluated on an independent test set (350 admissions) and yielded an area under curve (AUC) (95% confidence interval) of 0.893 (0.862–0.924). We compared the performance of our model against that of experienced clinicians. The RNN significantly outperformed clinicians (AUC = 0.901 vs. 0.745, p < 0.001) and was overall well calibrated. This was not the case for the physicians, who systematically underestimated the risk (p < 0.001). In conclusion, the RNN was superior to physicians in the prediction of AKI after cardiothoracic surgery. It could potentially be integrated into hospitals’ electronic health records for real-time patient monitoring and may help to detect early AKI and hence modify the treatment in perioperative care.

Download Full-text

Examining the Role of Acculturation in E-Cigarette Use among U.S. Immigrant Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073658 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3658

Author(s):

Sunday Azagba ◽

Lingpeng Shan

Keyword(s):

Host Country ◽

Odds Ratio ◽

Multivariable Analysis ◽

Population Data ◽

Cultural Norms ◽

Cigarette Use ◽

Length Of Residence ◽

Native Populations ◽

The U.S

Evidence suggests that as immigrants’ length of residence in the host country increases, they may integrate their behavior and norms to align with the new community’s cultural norms. The current study examined e-cigarette use among immigrants in the U.S., and whether the length of residence in the U.S. is associated with e-cigarette use among immigrants compared to the native-born population. Data were drawn from the 2014/15 and 2018/19 Tobacco Use Supplement to the Current Population Survey. Multivariable logistic regression was used to compare differences in e-cigarette use between native-born populations and immigrants, when immigrants’ length of residence in the U.S. was considered. Among immigrants, the prevalence of ever and current e-cigarette use increased significantly from 2.5% and 0.5% in 2014/2015 to 3.2% and 0.8% in 2018/2019, respectively. Multivariable analysis showed that immigrants had significantly lower odds of ever e-cigarette use compared to the mainland-born citizen (0–5 years in the U.S., adjusted Odds Ratio (aOR) 0.57, 95% Confidence Interval (CI) 0.46–0.69; 6–10 years, aOR 0.51, 95% CI 0.41–0.63; 11–20 years, aOR 0.45, 95% CI 0.39–0.53; 20+years, aOR 0.68, 95% CI 0.62–0.76). Similar results were found for current e-cigarette use, with immigrants being less likely to be current users. Findings that e-cigarette use among all immigrants—regardless of years living in the U.S.—was consistently lower than among the native-born population run contrary to the notion that as length of stay increases, health behaviors between immigrants and native populations of the host country become similar.

Download Full-text

Assessment of Cardiopulmonary Bypass Duration Improves Novel Biomarker Detection for Predicting Postoperative Acute Kidney Injury after Cardiovascular Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10132741 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2741

Author(s):

Tao Han Lee ◽

Cheng-Chia Lee ◽

Jia-Jin Chen ◽

Pei-Chun Fan ◽

Yi-Ran Tu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiopulmonary Bypass ◽

Fatty Acid Binding Protein ◽

Cardiovascular Surgery ◽

Kidney Injury ◽

Fatty Acid Binding ◽

Discriminatory Ability ◽

Postoperative Risk ◽

Study Population ◽

Postoperative Aki

Urinary liver-type fatty acid binding protein (L-FABP) is a novel biomarker with promising performance in detecting kidney injury. Previous studies reported that L-FABP showed moderate discrimination in patients that underwent cardiac surgery, and other studies revealed that longer duration of cardiopulmonary bypass (CPB) was associated with a higher risk of postoperative acute kidney injury (AKI). This study aims to examine assessing CPB duration first, then examining L-FABP can improve the discriminatory ability of L-FABP in postoperative AKI. A total of 144 patients who received cardiovascular surgery were enrolled. Urinary L-FABP levels were examined at 4 to 6 and 16 to 18 h postoperatively. In the whole study population, the AUROC of urinary L-FABP in predicting postoperative AKI within 7 days was 0.720 at 16 to 18 h postoperatively. By assessing patients according to CPB duration, the urinary L-FABP at 16 to 18 h showed more favorable discriminating ability with AUROC of 0.742. Urinary L-FABP exhibited good performance in discriminating the onset of AKI within 7 days after cardiovascular surgery. Assessing postoperative risk of AKI through CPB duration first and then using urinary L-FABP examination can provide more accurate and satisfactory performance in predicting postoperative AKI.

Download Full-text

Sex-Related Anatomical Feasibility Differences in Endovascular Repair of Thoracoabdominal Aortic Aneurysms With Multibranched Stent-Grafts

Journal of Endovascular Therapy ◽

10.1177/1526602820964916 ◽

2020 ◽

pp. 152660282096491

Author(s):

Alessandro Grandi ◽

Niccolò Carta ◽

Tommaso Cambiaghi ◽

Victor Bilman ◽

Germano Melissano ◽

...

Keyword(s):

Vascular Access ◽

Endovascular Repair ◽

Odds Ratio ◽

Multivariable Analysis ◽

Aortic Aneurysms ◽

Clinical Factors ◽

Stent Grafts ◽

Single Institution ◽

Confounding Variables ◽

Instructions For Use

Purpose: To evaluate the potential anatomical feasibility of using the off-the-shelf multibranched Zenith t-Branch for the treatment of thoracoabdominal aortic aneurysms (TAAAs) in female patients. Materials and Methods: A total of 268 patients (median age 68 years; 69 women) with degenerative TAAA treated at a single institution by means of open or endovascular repair between 2007 and 2019 were retrospectively analyzed to determine the feasibility of using the Zenith t-Branch based on the manufacturer’s instructions for use. The factors determining overall anatomical feasibility were divided into vascular access, aortic anatomy, and visceral vessels. The results were stratified by sex and compared. A logistic regression model was constructed to determine any association between feasibility and clinical factors or potential confounding variables; results are expressed as the odds ratio (OR) with 95% confidence interval (CI). Results: The overall anatomical feasibility was 39% (22% women vs 45% men, p=0.001). The feasibility was negatively influenced by female sex (p<0.001) in multivariable analysis (OR 2.9, 95% CI 1.5 to 5.4, p=0.001). Vascular access feasibility was 82% (61% women vs 89% men, p<0.001). Aorta feasibility was 65% (52% women vs 69% men, p<0.001), and visceral vessel feasibility was 74% (78% women vs 73% men, p=0.260). An access diameter ≤8.5 mm excluded 17% of the patients (39% women vs 9% men, p<0.001). The aortic feasibility was limited by the infrarenal aortic diameter in 16% of patients (45% women vs 6% men, p<0.001) and the aortic lumen at the visceral vessels in 17% patients (19% women vs 17% men, p=0.741). The visceral vessel feasibility was mainly limited by inadequate numbers or diameters of target vessels. Location and orientation of the target vessels were adequate in 96% of patients. Conclusion: A little more than a third of an all-comers cohort of patients with degenerative TAAA could have been treated with on-label use of the Zenith t-Branch. However, only 22% of women could have been treated because of sex-related anatomical limitations. New generations of multibranched devices should address these differences.

Download Full-text