scholarly journals Acute Renal Injury in Cardiac Surgery Patients

2020 ◽  
Vol 9 (3) ◽  
pp. 383-390
Author(s):  
S. I. Rey ◽  
G. A. Berdnikov ◽  
L. N. Zimina ◽  
N. V. Rubtsov ◽  
M. K. Mazanov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Postoperative Period ◽  
Renal Injury ◽  
Acute Renal Injury ◽  
Group 1

Background. Acute kidney injury following cardiac surgery remains a common and serious complication.Aim of study. To identify risk factors for the development and morphological features of acute renal injury, to assess the use of renal replacement therapy in patients after cardiac surgery.Material and methods. The study involved 66 patients who were treated in the Department of Cardiac Resuscitation of the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2009 to 2018. Of these, 45 men (68.2%) and 21 women (31.8%). The mean age of the patients was 56.3±13.2 years. Clinical and anatomical analysis of material from 19 deceased patients was carried out. Depending on the use of methods of renal replacement therapy, patients were divided into two groups: Group 1 included 23 patients with acute renal injury requiring the use of renal replacement therapy; Group 2 included 43 patients where methods of renal replacement therapy were not used.Results. Hospital mortality in Group 1 was lower (34.8 and 41.9%, respectively), however, the differences were statistically insignificant (p=0.372). To identify the factors in the development of acute renal damage, a stepwise regression analysis was performed by constructing a regression model of Cox proportional hazards. Age, history of chronic kidney disease, serum creatinine level on the first day after surgery, severity of the condition according to the APACHE-II scale, increased lactate level on day 2 of the postoperative period, decreased urine output on the first day after surgery were statistically significant.Conclusion. Risk factors for the development of ARI after cardiac surgery under cardiopulmonary bypass are advanced age, CKD in history, the severity of the patient’s condition, assessed by the APACHE-II scale, increased serum creatinine on the first day after surgery, increased lactate on day 2 of the postoperative period, a decreased diuresis on day 1 after surgery. The use of RRT in patients after surgery under the conditions of AC was accompanied by a tendency to improve treatment results: in-hospital mortality in the group of patients who underwent RRT was 34.8% versus 41.9% in the group without RRT methods. Morphological and functional features of renal failure in patients with ARI were preceding chronic renal pathological processes of different etiology, mainly affecting the glomeruli, vessels and stroma, as well as acute pathological processes aggravating ARI (dyscirculatory disorder, degenerative changes, necrosis and necrobiosis tubular epithelium).

Single-center experience with intraoperative extracorporeal membrane oxygenation use in lung transplantation

2017 ◽  
Vol 41 (2) ◽  
pp. 89-93 ◽  
Author(s):  
Tugba Cosgun ◽  
Sandra Tomaszek ◽  
Isabelle Opitz ◽  
Markus Wilhelm ◽  
Macé M. Schuurmans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Replacement Therapy ◽  
Support Group ◽  
Ecmo Support ◽  
Independent Risk Factors ◽  
Group 2 ◽  
Group 1

Background: Studies have shown that survival after lung transplantation is impaired if extracorporeal membrane oxygenation (ECMO) support is implemented. We investigated the outcome and potential independent risk factors on survival in recipients undergoing lung transplantation with intraoperative ECMO support. Materials and methods: Medical records of recipients were retrospectively evaluated (January 2000-December 2014). Retransplantation and bridge to transplantation on ECMO were excluded. Recipients (n = 291) were divided into 2 groups: those who needed intraoperative ECMO support (Group 1, n = 134) and those who did not receive intraoperative ECMO support (Group 2, n = 157). Independent risk factors were identified by a stepwise backward regression analysis. Results: 1-year survival was 84.2% in Group 1 vs. 90.4% in Group 2, and 5-year survival was 52.8% in Group 1 vs. 70.5% in Group 2 (p = 0.002). Multivariate analysis indicated that recipient age (p = 0.001), renal replacement therapy (p = 0.001) and intraoperative ECMO support (p = 0.03) were significant risk factors for overall survival. The rate of postoperative early surgical complications was comparable between the two groups (p = 0.09). The number of patients requiring renal replacement therapy and experiencing late pulmonary complications was significantly higher in Group 1 (p = 0.02). Conclusions: Our data showed that lung transplantation with intraoperative ECMO support is associated with poor outcomes.

scholarly journals HOSPITAL MORTALITY OF CARDIAC SURGERY PATIENTS WITH ACUTE KIDNEY INJURY ON RENAL REPLACEMENT THERAPY

2014 ◽  
pp. 8-14
Author(s):  
К. Zakon ◽  
М. Kolesnyk ◽  
V. Dudarenko ◽  
G. Radchenko
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Kidney Injury

The purpose of this study was to compare the influence of different modalities of renal replacement therapy (RRT) on outcome of cardiac surgery patients (pts) with acute kidney injury (AKI).

scholarly journals Characteristics And Outcomes of Sepsis Patients With And Without COVID-19

2021 ◽  
Author(s):  
Lars Heubner ◽  
Sarah Hattenhauer ◽  
Andreas Güldner ◽  
Paul Petrick ◽  
Martin Roessler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
University Hospital ◽  
Adjusted Relative Risk ◽  
Invasive Ventilation ◽  
Icu Patients ◽  
Medical Icus

Abstract Background: The aim of this study was to describe and compare clinical characteristics and outcomes in critically ill septic patients with and without COVID-19.Methods: From February 2020 to March 2021, patients from surgical and medical ICUs at the University Hospital Dresden were screened for sepsis. Patient characteristics and outcomes were assessed descriptively. Patient survival was analyzed using the Kaplan-Meier estimator. Associations between in-hospital mortality and risk factors were modeled using robust Poisson regression, which facilitates derivation of adjusted relative risks.Results: In 177 ICU patients treated for sepsis, COVID-19 was diagnosed and compared to 191 septic ICU patients without COVID-19. Age and sex did not differ significantly between sepsis patients with and without COVID-19, but SOFA score at ICU admission was significantly higher in septic COVID-19 patients. In-hospital mortality was significantly higher in COVID-19 patients with 59% compared to 29% in Non-COVID patients. Statistical analysis resulted in an adjusted relative risk for in-hospital mortality of 1.74 (95%-CI=1.35-2-24) in the presence of COVID-19 compared to other septic patients. Age, procalcitonin maximum value over 2 ng/ml, need for renal replacement therapy, need for invasive ventilation and septic shock were identified as additional risk factors for in-hospital mortality.Conclusion: COVID-19 was identified as independent risk factor for higher in-hospital mortality in sepsis patients. The need for invasive ventilation and renal replacement therapy as well as the presence of septic shock and higher PCT should be considered to identify high-risk patients.

MO410URINARY NGAL:HEPCIDIN-25 RATIO VERSUS URINARY NGAL FOR EARLY IDENTIFICATION OF PATIENTS AT RISK FOR ACUTE RENAL REPLACEMENT THERAPY AND DEATH AFTER CARDIAC SURGERY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Saban Elitok ◽  
Anja Haase-Fielitz ◽  
Martin Ernst ◽  
Michael Haase
Keyword(s):  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
High Risk ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Early Identification ◽  
Area Under The Curve ◽  
Discriminatory Power ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background and Aims Acute kidney injury requiring renal replacement therapy (AKI-RRT) is strongly associated with mortality after cardiac surgery, however, options for early identification of patients at high-risk for AKI-RRT are extremely limited. Early after cardiac surgery, the predictive ability for AKI-RRT even of one of the most extensively evaluated novel urinary biomarkers, neutrophil gelatinase-associated lipocalin (NGAL), appears to be only moderate. We aimed to determine whether the discriminatory power and reclassification indices of NGAL:hepcidin-25-ratio (urinary concentrations of NGAL divided by that of hepcidin-25) within 60 min after end of surgery compare favorably to NGAL alone for identification of high-risk patients after cardiac surgery. We also aimed to determine whether an increased NGAL:hepcidin-25-ratio can detect subclinical AKI (no serum creatinine- or urine output-based criteria for AKI). Method This is a prospective substudy of the BICARBONATE trial, a multicenter parallel-randomized controlled trial comparing perioperative bicarbonate infusion for AKI prevention to usual patient care. At a tertiary referral center, 198 patients at increased kidney risk undergoing cardiac surgery with cardiopulmonary bypass were included into the present study. The primary outcome measure was defined as AKI-RRT. Secondary outcomes were in-hospital mortality and ratio-defined subclinical AKI characterized by increased odds for AKI-RRT or in-hospital mortality. We compared biomarkers’ area-under-the-curve of the receiver-operating-characteristic and performed cross-validated reclassification statistics and regression analysis adjusted to Cleveland risk score/EuroScore, cross-clamp time, age and volume of packed red blood cells. Results Patients with AKI-RRT (n=13) had 13.7-times higher NGAL and 3.3-times lower hepcidin-25 concentrations resulting in 46.9-times higher NGAL:hepcidin-25-ratio early after surgery compared to patients without AKI-RRT (Figure 1). The NGAL:hepcidin-25-ratio had higher discriminatory power compared with NGAL for risk of AKI-RRT and in-hospital mortality (area-under-the-curve difference 0.087, 95% CI, 0.036 to 0.138, P<0.001; 0.082, 95% CI, 0.018 to 0.146, P=0.012). The NGAL:hepcidin-25-ratio, but not NGAL, was independently associated with AKI-RRT (adjusted OR per 1-SD higher lnNGAL:hepcidin-25-ratio, 1.524, 95% CI, 1.046 to 2.222, P=0.028). The NGAL:hepcidin-25-ratio increased category-free net-reclassification-improvement for AKI-RRT (0.690, 95% CI, 0.146 to 1.234, P=0.013) and in-hospital mortality (cfNRI 0.744, 95% CI, 0.201 to 1.288, P=0.007). NGAL:hepcidin-25-ratio-positive subclinical AKI was associated with increased AKI-RRT (OR 10.02, 95% CI, 1.59 to 63.39; P<0.001) and in-hospital mortality rates (OR 41.07, 95% CI, 4.31 to 391.40; P<0.001). Conclusion The urinary NGAL:hepcidin-25-ratio appears to early identify high-risk patients and outperform NGAL after cardiac surgery. Also, the urinary NGAL:hepcidin-25 ratio can detect subclinical AKI. Confirmation of our findings in other cardiac surgery centers is now needed.

scholarly journals SO020NEPHROLOGY INTERVENTION IN PATIENTS AWAITING CARDIAC SURGERY: A RANDOMISED CONTROLLED TRIAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sergi Codina ◽  
Ana Coloma ◽  
Fabrizio Sbraga ◽  
Enric Boza ◽  
Jose Maria Vazquez-Reveron ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Controlled Trial ◽  
Kidney Injury ◽  
Categorical Variables

Abstract Background and Aims Acute kidney injury (AKI) is a frequent complication after cardiac surgery. Its incidence ranges from 19 to 44% depending on the study and which definition is used. There are some well-known risk factors associated with AKI, including baseline patient characteristics (age and comorbidities), need of perioperative blood transfusion or presence of previous chronic kidney disease. We wanted to evaluate if a nephrologist management and control of potential risk factors of renal disease can be used to prevent AKI, thereby minimizing the risk of need RRT, reducing costs and improving survival in these patients. It will be the first study focused on this intervention. The aim of this study is to assess if a nephrology intervention before cardiac surgery can reduce the postoperative incidence of AKI. Method Unicentric prospective randomized controlled trial of 298 participants from 2015 to 2019. The inclusion criteria was patients undergoing scheduled cardiac surgery of > 18 years old. The exclusion criteria was a requirement for renal replacement therapy before surgery. Clinical Research Ethics Committee of Bellvitge has approved the study before initiation. All patients have given written informed consent. We have done an intention-to-treat analysis, continuous variables have been compared between groups using Student's t test and categorical variables using X2. Results Nephrology intervention before surgery, included a preoperative study done minimum 1 month before the surgery to optimize the patient’ s overall condition by optimization of hydration state, remove or minimize dose of drugs that potentially deteriorate kidney function and correct metabolic disorders. No differences in the characteristics of the patients between groups was found (Table 1). The number of patients with AKI were 49 without differences between groups (0.112), with most of them presenting a stage 1 AKI, only 3 patients present a stage 3 AKI, but none of them required renal replacement therapy (Table 2). We found 1.3% of mortality (1 participant in the intervention group and 3 in control group). Data at 1 year follow-up (n= 144) showed low incidence of kidney disease (creatinine in intervention arm 91.87±30.79μmol/L and in control arm 87.08±23.58, p=0.292) without differences in albuminuria. Conclusion In summary, we did not find any difference in acute kidney injury and death when a nephrology intervention is done to cardiac surgery patients, probably it would be necessary to increase the sample size to make conclusions. The results at 1 year follow-up showed no kidney disease in these patients.

scholarly journals Early initiation of renal replacement therapy in acute renal injury

2017 ◽  
Vol 19 (76) ◽  
pp. 131-139
Author(s):  
O. Torres Aguilar ◽  
R.J. Maya Quintá ◽  
G. Rodríguez Prieto ◽  
M. Leal ◽  
J.F. Castilleja Leal
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Renal Injury ◽  
Early Initiation ◽  
Acute Renal Injury

scholarly journals Acute Kidney Injury After Cardiac Surgery - Risk Factors for Renal Replacement Therapy

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Lahdenperä N-I ◽  
Suojaranta-Ylinen RT ◽  
Nisula S ◽  
Schramko AA
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury

MO405RISC FACTORS FOR CARDIAC SURGERY-ASSOCIATED ACUTE KIDNEY INJURY IN A TERTIARY REFERRAL HOSPITAL

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alvaro Lucas ◽  
Ali­cia Molina Andujar ◽  
Eduard Quintana ◽  
Gaston Piñeiro ◽  
Esteban Poch
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Extracorporeal Circulation ◽  
Kidney Injury ◽  
Preventive Strategies ◽  
Factors Associated ◽  
Ischaemia Time

Abstract Background and Aims cardiac surgery-associated acute kidney injury (CS-AKI) is a frequent complication that confers significant increase in morbility and mortality. It is still unclear how to identify patients at high risk to develop it, in order to apply to them early preventive strategies to avoid AKI. The study aimed to explore risk factors associated to CS-AKI. Method to analyze the association between demographic, pre-operative and intraoperative variables with all grades-AKI, we collected baseline characteristics, type of surgery, aortic time of clampage and extracorporeal circulation time, hemodinamic variables during surgery, Euroscore II, Clevelant Clinic Score and Leicester cardiosurgery score. The post-operative variables included monitorization of the first 24 h in the Intensive Care Units (ICU), consistent in: use of vasoactive drugs, total diuresis, use of furosemide, need of transfusions and need and duration of renal replacement therapy (RRT). Creatinine was collected for all the admision days in order to calculate the incidence of AKI. Also mortality and need of RRT at 30 th day was assessed. The inclusion criteria were: patients over 18 years old who underwent cardiac surgery with extracorporeal circulation. Only valve substitution (VS), Coronary Artery Bypass Graft (CABG) or a combination of both procedures (not including endocarditis surgery) were included. Patients who were already in dialysis or suffered an AKI just before the surgery were not included in the study. Results we included 130 patients who underwent heart surgery intervention in Hospital Clínic de Barcelona from 1st January to 31 st March 2015. 61,5% were men and the majority of them was 60 - 75 years old (46.9%), with hypertension (80.8%), without diabetes (68.5%), with stage 2-Chronic Kidney Disease (53.1%). Main surgical procedure was CABG (50.8%), followed by valve substitution (36.1%) and combination of both (13.1%). 73,1% of the procedures were done electively and 26.9% urgently. Out of the 130 patients, 60 (46.2%) suffered an AKI (36 AKIN 1, 16 AKIN 2 and 8 AKIN3). The majority of the episodes (55.2%) started between 24 and 48 hours after the intervention and 7 patients required RRT. AKI was not associated with mortality or need of renal replacement therapy at 30 days (OR 1.853, p= 0.397). Regarding risk factors for CS-AKI, basal eGFR <60 ml/min, history of hypertension, age and the clevelant/leicester and euroscore were preoperative risk factors associated with CS-AKI in our cohort (OR 5.571 p=<0.001; OR 2.621 p=0.043; OR 1.036 p<0.001; OR 1.453 p=0.045; OR 1.062 p<0.001; OR 1.351 p=0.006 respectively). Leicester cardiosurgery score >30 was the score who showed the best association with AKI (OR 5.167, p<0.001). Intraoperative significant risk factors that were identified were: ischaemia time over 70 minutes (OR 2.876, p=0.004), and the need to use phenylephrine (3.064, p=0.015); whereas the need to use nitroglycerin was identified as a protector (OR 0.441, p=0.031). Conclusion previous eGFR<60 ml/min, age, hypertension, use of phenylephrine during surgery and long ischaemia time are the main factors associated with CS-AKI. Scores like Leicester score can help physicians to identify people at risk and apply preventive strategies.

scholarly journals Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chang Liu ◽  
Hai-Tao Zhang ◽  
Li-Jun Yue ◽  
Ze-Shi Li ◽  
Ke Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Intraoperative Bleeding ◽  
Independent Risk Factors ◽  
Mechanical Ventilation Time

Abstract Background To investigate the risk factors for mortality in patients with acute kidney injury requiring continuous renal replacement therapy (AKI-CRRT) after cardiac surgery. Methods In this retrospective study, patients who underwent AKI-CRRT after cardiac surgery in our centre from January 2015 to January 2020 were included. Univariable and multivariable analyses were performed to identify the risk factors for in-hospital mortality. Results A total of 412 patients were included in our study. Of these, 174 died after AKI-CRRT, and the remaining 238 were included in the survival control group. Multivariable logistic regression analysis revealed that EuroSCORE > 7 (odds ratio [OR], 3.72; 95% confidence interval [CI], 1.92–7.24; p < 0.01), intraoperative bleeding > 1 L (OR, 2.14; 95% CI, 1.19–3.86; p = 0.01) and mechanical ventilation time > 70 h (OR, 5.03; 95% CI, 2.40–10.54; p < 0.01) were independent risk factors for in-hospital mortality in patients who had undergone AKI-CRRT. Our study also found that the use of furosemide after surgery was a protective factor for such patients (odds ratio, 0.48; 95% confidence interval, 0.25–0.92; p = 0.03). Conclusions In summary, the mortality of patients with AKI-CRRT after cardiac surgery remains high. The EuroSCORE, intraoperative bleeding and mechanical ventilation time were independent risk factors for in-hospital mortality. Continuous application of furosemide may be associated with a better outcome.

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