Acute Kidney Injury after a Coronary Artery Bypass Graft Surgery

Abstract

Coronary artery bypass graft (CABG) is performed on patients with blocked coronary arteries by creating a shortcut to resolve and improve blood flow to the heart muscle. The CABG procedure can be performed using a cardiopulmonary bypass (CPB) or an off-pump artery bypass graft technique. One complication in heart surgery is acute kidney injury (AKI) incidence. The risk factors in the incidence of AKI include CPB, complications from surgery (e.g., bleeding and blood transfusions), type of surgery, preoperative high-osmolarity state, preoperative serum creatinine level, age >60 years, the presence of comorbid conditions (e.g., hypertension, diabetes, and dyslipidemia), impaired left ventricular function, hemodynamic disturbances, hypoperfusion, use of vasopressor drugs/inotropes, and preoperative hypoalbuminemia. We report an observation to six of our recent patients underwent CABG aged 36–69 years old. Five patients with coronary arterial diseases (CAD) underwent CABG, and one patient with CAD and mitral regurgitation underwent CABG surgery and mitral valve replacement. All patients had a preoperative albumin level of >3.5 g/dL. Two patients developed AKI <24 h postsurgery and three followed by the next day. Serum creatinine monitoring was carried out daily for 7 days, where two patients showed improvement in serum creatinine, and other two had their creatinine returned to normal. This case series found that AKI incidence after CABG was relatively high despite an excellent clinical outcome. Further research is needed with a larger number of cases to find the risk factors for AKI for perioperative prevention.

Role of neutrophil gelatinase-associated lipocalin (NGAL) as a acute prerenal kidney injury marker: Exploring factors associated with its postoperative levels in hypotension-controlled otorhinolaryngology surgery

“…Most patients only experienced AKI for a short time and then recovered. 29 The incidence of AKI after CABG with CPB in Dr Soetomo General Academic Surabaya was more than half of the total cases worked on, and most of them occurred on the first postoperative day. 29 This study had several limitations.…”

“…29 The incidence of AKI after CABG with CPB in Dr Soetomo General Academic Surabaya was more than half of the total cases worked on, and most of them occurred on the first postoperative day. 29 This study had several limitations. The number of patients might be relatively small to determine the correlation, which might explain our study's result.…”