scholarly journals Serum lactate as reliable biomarker of acute kidney injury in low-risk cardiac surgery patients

2019 ◽  
Vol 38 (2) ◽  
pp. 118-125 ◽  
Author(s):  
Mina Radovic ◽  
Suzana Bojic ◽  
Jelena Kotur-Stevuljevic ◽  
Visnja Lezaic ◽  
Biljana Milicic ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Odds Ratio ◽  
Lactate Concentration ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Low Risk ◽  
Significant Independent Predictor ◽  
Elective Cardiac Surgery ◽  
Kidney Injury Molecule 1

Summary Background Cardiac surgery-associated acute kidney injury (CSA-AKI) frequently occurs in patients assessed as low-risk for developing CSA-AKI. Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule-1 (KIM-1) and lactate are promising biomarkers of CSA-AKI but have not yet been explored in low-risk patients. Aim To evaluate urinary NGAL (uNGAL), KIM-1 and lactate as biomarkers of CSA-AKI in patients with low-risk for developing CSA-AKI. Methods This prospective, observational study included 100 adult elective cardiac surgery patients assessed as low-risk for developing CSA-AKI. UNGAL, KIM-1 and lactate were measured preoperatively, at the end of cardiopulmonary bypass (CPB) and 3, 12, 24 and 48 h later. Results Fifteen patients developed CSA-AKI. Patients with CSA-AKI had significantly higher lactate but similar uNGAL and KIM-1 levels compared to patients without CSA-AKI. Unlike uNGAL and KIM-1, postoperative lactate was good biomarker of CSA-AKI with the highest odds ratio (OR) 2.7 [1.4–4.9] 24 h after CPB. Peak lactate concentration ≥ 4 mmol/L carried dramatically higher risk for developing CSA-AKI (OR 6.3 [1.9–20.5]). Conclusions Unlike uNGAL and KIM-1, postoperative lactate was significant independent predictor of CSA-AKI with the highest odds ratio 24 h after CPB.

scholarly journals Acute kidney injury prediction following elective cardiac surgery: AKICS Score

2007 ◽  
Vol 72 (5) ◽  
pp. 624-631 ◽  
Author(s):  
H. Palomba ◽  
I. de Castro ◽  
A.L.C. Neto ◽  
S. Lage ◽  
L. Yu
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Injury Prediction ◽  
Elective 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 ◽  
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.

Relation between Prolonged Cardiopulmonary Bypass Time in Cardiac Surgery in Adult Patients and Post-Operative Acute Kidney Injury

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abd-El Khalek Mohamed Ali ◽  
Diaa Abd-El Khalek Akl ◽  
Mohamed Samir Mohamed Salama
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Adult Patients ◽  
Cardiopulmonary Bypass Time ◽  
Elective Cardiac Surgery ◽  
Short And Long Term ◽  
Long Term Prognosis

Abstract Background Cardiac-surgery associated acute kidney injury (CSA-AKI) remains an important and frequent complication in patients undergoing cardiac surgery and is associated with a poor short- and long-term prognosis. The incidence for CSA-AKI according to Acute Kidney Injury Network criteria (AKIN) varies between 3% and 50%. CSA-AKI requiring temporary renal replacement therapy (RRT) occurs in 5% to 20% of these patients and is associated with a high mortality rate. Objective To detect the relation between prolonged cardiopulmonary bypass time in cardiac surgery and the incidence of post-operative acute kidney injury. Patients and Methods This is an observational retrospective study conducted on (80) adult patients who underwent elective cardiac surgery at Aswan Heart Centre (Magdi Yacoub Foundation) after the approval of the Ethical Medical Committee of Aswan Heart Centre. Results Results of the statistical analysis of the present study showed that mean CPB duration was prolonged in the AKI group of patients (155 min) than the non-AKI group of patients (129 min). Conclusion Prolonged cardiopulmonary bypass duration may be an independent risk factor for acute kidney injury post cardiac surgery in adult patients.

scholarly journals The correlation of post-operative acute kidney injury and perioperative anaemia in patients undergoing cardiac surgery with cardiopulmonary bypass

2019 ◽  
Vol 26 (1) ◽  
pp. 79-86
Author(s):  
Tautvydas Baranauskas ◽  
Agnė Kaunienė ◽  
Milda Švagždienė ◽  
Edmundas Širvinskas ◽  
Tadas Lenkutis
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Chronic Renal Disease ◽  
Kidney Injury ◽  
Average Concentration ◽  
Clinical Syndrome ◽  
Systemic Autoimmune Disease ◽  
Elective Cardiac Surgery ◽  
The Impact

Background and objective. Acute kidney injury (AKI) following cardiac surgery with cardiopulmonary bypass (CPB) is polyethiological clinical syndrome. During CPB haemodilution develops, which is useful in reducing the risk of thrombosis; however, haemodilutional anaemia decreases oxygen transfer and provokes tissue hypoxia, which can lead to acute organ damage. The aim of the study was to find out the impact of perioperative anaemia on AKI after cardiac surgery with CPB. Materials and methods. This prospective study included 58 adult patients undergoing elective cardiac surgery with CPB, without any preoperative chronic renal disease or any systemic autoimmune disease. Serum concentrations of NGAL had been tested before the surgery, 2 hours, 6 hours, and one day after the surgery. Perioperative anaemia was assessed according to the Ht value before the surgery, the Ht value during CPB, and immediately after the surgery. Results. The rate of haemodilutional anaemia is 77.59% in this study. The average of serum NGAL concentration before CPB was 63.95 ± 33.25 ng/mL and it was significantly lower than the average concentration 2 hours after the surgery, 6 hours after the surgery and one day after the surgery (respectively 148.51 ± 62.39, 119.44 ± 55, 128.70 ± 59.04 ng/mL, p < 0.05). AKI developed in 46.55% of the patients. A significant positive reasonable correlation between the development of perioperative anaemia and AKI was determined (r = 0.50, p < 0.05). Conclusions. Post-operative AKI after cardiac surgery with CPB has a moderate positive correlation with perioperative haemodilutional anaemia. A longer CPB time and aortic cross-clamping time were found to be the risk factors for the development of AKI.

scholarly journals The Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass

2021 ◽  
Vol 9 ◽  
Author(s):  
Fan Cao ◽  
Xinxin Chen ◽  
Guodong Huang ◽  
Wenhua Liu ◽  
Na Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Cardiopulmonary Bypass ◽  
Ventricular Septal Defect ◽  
Independent Risk Factor ◽  
Septal Defect ◽  
Kidney Injury ◽  
Elective Cardiac Surgery

Background: Acute kidney injury (AKI) is a common and serious complication faced by children following ventricular septal defect (VSD) surgery with cardiopulmonary bypass (CPB). The objective of this study was to explore potential predictors inherent to AKI.Methods: VSD infants who were scheduled for elective cardiac surgery with CPB from 2017 to 2020 were enrolled in this study. Based on the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria, patients were divided into AKI and non-AKI groups. Univariate and multivariate logistic regression analyses were carried out in order to evaluate potential risk factors for AKI. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive probabilities of risk factors for AKI.Results: Of all the 338 enrolled VSD infants, 49 manifested AKI with an incidence of 14.5% (49/338). The ROC curve indicated that albumin-to-fibrinogen ratio (AFR) during CPB was a significant predictor of AKI [area under the curve (AUC), 0.711; p &lt; 0.001]. Based on the univariate and multivariate logistic analyses, AFR during CPB [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.22–2.76, p = 0.011] was the only independent risk factor for AKI.Conclusions: This study demonstrated that a low AFR (&lt;9.35) during CPB was an independent risk factor for AKI in VSD infants following cardiac surgery with CPB.

Abstract 16196: Nitric Oxide Delivery During Cardiopulmonary Bypass Reduces Acute Kidney Injury: Randomized Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nikolay O Kamenshchikov ◽  
Yuriy K Podoksenov ◽  
Yana J Anfinogenova ◽  
Boris N Kozlov
Keyword(s):  
Nitric Oxide ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Treatment Group ◽  
Kidney Injury ◽  
Controlled Study ◽  
Moderate Risk ◽  
Elective Cardiac Surgery ◽  
Renal Complications

Introduction: Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB). Postoperative AKI develops in 30% to 52% of cardiac surgery patients and 2% to 5% of these patients require renal replacement therapy. Hypothesis: We hypothesized that nitric oxide treatment during cardiac surgery with CPB can decrease AKI incidence in adult patients. The aim of study was to evaluate the effects of nitric oxide supplementation to CPB circuit on the development of cardiac surgery-associated AKI. Methods: A prospective randomized controlled study included 96 patients with moderate risk of renal complications who underwent elective cardiac surgery with CPB. The study protocol was registered at www.clinicaltrials.gov (#NCT03527381). Patients were randomly assigned to either the nitric oxide supplementation to CPB circuit (NO-treatment group, n = 48) or the usual care (control group, n = 48). 40-ppm nitric oxide was administered in NO-treatment group during the entire CPB period. The primary outcome was AKI incidence. Results: Nitric oxide treatment was associated with a significant decrease in AKI incidence (10 (20.8%) versus 20 (41.6%); RR 0.5 (95% CI 0.26-0.95; p =0.023) and a higher urine output during CPB (2.6 [2.1;5.08] versus 1.7 [0.80;2.50] mL/kg/h; p = 0.0002). Urinary neutrophil gelatinase-associated lipocalin levels were significantly lower in NO-treatment group 4 h after surgery: 1.12 [0.75;5.8] versus 4.62 [2.02;34.55] ng/mL; p = 0.005. Concentrations of nitric oxide metabolites in NO-treatment group significantly increased at 5 min post-clamping, 5 min after declamping, and at the end of surgery. The concentrations of proinflammatory and anti-inflammatory mediators and free plasma hemoglobin did not significantly differ between groups. Conclusions: Nitric oxide administration to patients at moderate risk of renal complications undergoing elective cardiac surgery with CPB was associated with a decrease in AKI incidence. The implications of study for clinical practice expand the array of methods, which may be used for prevention of AKI in cardiac surgery patients.

scholarly journals COMT-Val158Met-Polymorphism Is Not a Risk Factor for Acute Kidney Injury after Cardiac Surgery

2013 ◽  
Vol 35 ◽  
pp. 129-134 ◽  
Author(s):  
Matthias Kornek ◽  
Marcus-André Deutsch ◽  
Stefan Eichhorn ◽  
Harald Lahm ◽  
Stefan Wagenpfeil ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Linear Regression Analysis ◽  
Kidney Injury ◽  
Aortic Cross Clamp Time ◽  
Pilot Studies ◽  
Elective Cardiac Surgery ◽  
Perioperative Morbidity

Background. Cardiac surgery-associated acute kidney injury (CSA-AKI) depicts a major complication after cardiac surgery using cardiopulmonary bypass (CPB).Objective. CSA-AKI has clearly been linked to increased perioperative morbidity and mortality. Dysregulations of vasomotor tone are assumed to be causal for CSA-AKI. While catechol-O-methyltransferase (COMT) is involved in metabolizing catecholamines, a single-nucleotide polymorphism (SNP) in the COMT gene leads to different enzyme activities according to genotype. Pilot studies found associations between those COMT genotypes and CSA-AKI.Methods. We prospectively included 1741 patients undergoing elective cardiac surgery using cardiopulmonary bypass (CPB). Patients were genotyped for COMT-Val158Met-(G/A) polymorphism (rs4680).Results. Demographic characteristics and procedural data revealed no significant differences between genotypes. No association between COMT genotypes and the RIFLE criteria could be detected. A multiple linear regression analysis for postoperative creatinine increase revealed highly significant associations for aortic cross-clamp time (P<0.001), CPB time (P<0.001), norepinephrine (P<0.001), and age (P<0.001). No associations were found for COMT genotypes or baseline creatinine. With anR2=0.39and a sample size of 1741, the observed power of the regression analysis was >99%.Conclusions. Based on our results, we can rule out an association between the COMT-Val158Met-(G/A) polymorphism and the appearance of CSA-AKI.

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