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

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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Risk factors of cardiac surgery-associated acute kidney injury: development and validation of a perioperative predictive nomogram

Journal of Nephrology ◽

10.1007/s40620-019-00624-z ◽

2019 ◽

Vol 32 (6) ◽

pp. 937-945 ◽

Cited By ~ 4

Author(s):

Chen Guan ◽

Chenyu Li ◽

Lingyu Xu ◽

Li Zhen ◽

Yue Zhang ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Injury ◽

Acute Kidney Injury Development ◽

Development And Validation

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Intraoperative hyperglycemia in patients with an elevated preoperative C-reactive protein level may increase the risk of acute kidney injury after cardiac surgery

Journal of Anesthesia ◽

10.1007/s00540-020-02849-w ◽

2020 ◽

Author(s):

Seohee Lee ◽

Seungpyo Nam ◽

Jinyoung Bae ◽

Youn Joung Cho ◽

Yunseok Jeon ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Protein Level ◽

Kidney Injury ◽

C Reactive Protein ◽

Reactive Protein

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Predictors of Acute Kidney Injury After Hip Fracture in Older Adults

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320920088 ◽

2020 ◽

Vol 11 ◽

pp. 215145932092008 ◽

Cited By ~ 3

Author(s):

Julie Braüner Christensen ◽

Martin Aasbrenn ◽

Luana Sandoval Castillo ◽

Anette Ekmann ◽

Thomas Giver Jensen ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Hip Fracture ◽

Blood Transfusion ◽

Multivariable Analysis ◽

Kidney Injury ◽

C Reactive Protein ◽

Hip Fracture Surgery ◽

Reactive Protein ◽

Fracture Surgery

Introduction: This study aimed to investigate the prevalence of acute kidney injury (AKI) following hip fracture surgery in geriatric patients and to identify predictors for development of AKI with a focus on possible preventable risk factors. Methods: In this retrospective cohort study, we reviewed electronic medical records of all patients above 65 years of age who underwent hip fracture surgery at Copenhagen University Hospital, Bispebjerg, Denmark, in 2018. Acute kidney injury was assessed according to the Kidney Disease Improving Global Outcomes guidelines. Multivariate logistic regression analyses were used to identify independent risk factors for AKI. Results: Postoperative AKI developed in 28.4% of the included patients (85/299). Acute kidney injury was associated with increased length of admission (11.3 vs 8.7 days, P < .001) and 30-day mortality (18/85 vs 16/214, P = .001). In multivariable analysis, higher age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.08, P = .004), heart disease (OR: 1.78, 95% CI: 1.01-3.11, P = .045), and postoperative blood transfusion (OR: 1.84, 95% CI: 1.01-3.36, P = .048) were associated with AKI. Moreover, a higher postoperative C-reactive protein (199.0 ± 99.9 in patients with AKI, 161.3 ± 75.2 in patients without AKI) and lower postoperative diastolic blood pressure were observed in patients developing AKI. Discussion and Conclusion: Acute kidney injury was common following hip fracture surgery and associated with longer admissions and increased mortality. Patients developing AKI were older and showed several postoperative similarities, including higher C-reactive protein, lower postoperative diastolic pressure, and the need for blood transfusion.

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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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Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: A prospective multicenter study*

Critical Care Medicine ◽

10.1097/ccm.0b013e31821201d3 ◽

2011 ◽

Vol 39 (6) ◽

pp. 1493-1499 ◽

Cited By ~ 234

Author(s):

Simon Li ◽

Catherine D. Krawczeski ◽

Michael Zappitelli ◽

Prasad Devarajan ◽

Heather Thiessen-Philbrook ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Multicenter Study ◽

Kidney Injury ◽

Pediatric Cardiac Surgery ◽

Prospective Multicenter Study ◽

Incidence Risk

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Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Medicine ◽

10.1097/md.0000000000002025 ◽

2015 ◽

Vol 94 (45) ◽

pp. e2025 ◽

Cited By ~ 46

Author(s):

Jia-Rui Xu ◽

Jia-Ming Zhu ◽

Jun Jiang ◽

Xiao-Qiang Ding ◽

Yi Fang ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Disease ◽

Kidney Injury ◽

Long Term Mortality

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Risk factors of acute kidney injury after pediatric cardiac surgery

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13264 ◽

2018 ◽

Vol 63 (2) ◽

pp. 274-275

Author(s):

Liujiazi Shao ◽

Fu Shan Xue ◽

He Yang

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Injury ◽

Pediatric Cardiac Surgery

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High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm8122192 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2192 ◽

Cited By ~ 2

Author(s):

Nicola Cosentino ◽

Stefano Genovese ◽

Jeness Campodonico ◽

Alice Bonomi ◽

Claudia Lucci ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Kidney Injury ◽

Kidney Injury ◽

High Sensitivity ◽

Future Research ◽

Hospital Death ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp

Background. Accumulating evidence suggests that inflammation plays a key role in acute kidney injury (AKI) pathogenesis. We explored the relationship between high-sensitivity C-reactive protein (hs-CRP) and AKI in acute myocardial infarction (AMI). Methods. We prospectively included 2,063 AMI patients in whom hs-CRP was measured at admission. AKI incidence and a clinical composite of in-hospital death, cardiogenic shock, and acute pulmonary edema were the study endpoints. Results. Two-hundred-thirty-four (11%) patients developed AKI. hs-CRP levels were higher in AKI patients (45 ± 87 vs. 16 ± 41 mg/L; p < 0.0001). The incidence and severity of AKI, as well as the rate of the composite endpoint, increased in parallel with hs-CRP quartiles (p for trend <0.0001 for all comparisons). A significant correlation was found between hs-CRP and the maximal increase of serum creatinine (R = 0.23; p < 0.0001). The AUC of hs-CRP for AKI prediction was 0.69 (p < 0.001). At reclassification analysis, addition of hs-CRP allowed to properly reclassify 14% of patients when added to creatinine and 8% of patients when added to a clinical model. Conclusions. In AMI, admission hs-CRP is closely associated with AKI development and severity, and with in-hospital outcomes. Future research should focus on whether prophylactic renal strategies in patients with high hs-CRP might prevent AKI and improve outcome.

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Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery

Scientific Reports ◽

10.1038/s41598-019-56615-4 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Miho Murashima ◽

Masatoshi Nishimoto ◽

Maiko Kokubu ◽

Takayuki Hamano ◽

Masaru Matsui ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cox Regression ◽

Kidney Injury ◽

Mediation Effects ◽

Loss To Follow Up ◽

Mediation Analyses ◽

Reactive Protein ◽

Markers Of Inflammation

AbstractThis retrospective cohort study examined the roles of inflammation in acute kidney injury (AKI). Serum albumin and C-reactive protein (CRP) were used as markers of inflammation. Adults who underwent non–cardiac surgery from 2007 to 2011 were included. Exclusion criteria were urological surgery, obstetric surgery, missing data, and pre-operative dialysis. Subjects were followed until the end of 2015 or loss to follow-up. Associations between pre–operative albumin or CRP and post-operative AKI or association between AKI and mortality were examined by logistic or Cox regression, respectively. Mediation analyses were performed using albumin and CRP as mediators. Among 4,538 subjects, 272 developed AKI. Pre-operative albumin was independently associated with AKI (odds ratio [95% confidence interval (CI)]: 0.63 [0.48–0.83]). During a median follow-up of 4.5 years, 649 died. AKI was significantly associated with mortality (hazard ratio [HR] [95% CI]: 1.58 [1.22–2.04]). Further adjustment for pre-operative albumin and CRP attenuated the association (HR [95% CI]: 1.28 [0.99–1.67]). The proportions explained by mediating effects of lnCRP and albumin were 29.3% and 39.2% and mediation effects were statistically significant. In conclusion, inflammation is a predictor of AKI and a mediator of mortality after AKI. Interventions targeting inflammation might improve outcomes of AKI.

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