Acute Kidney Injury following Cardiopulmonary Bypass: A Challenging Picture

Liu, Dianxiao; Liu, Baohui; Liang, Zhenxing; Yang, Zhi; Ma, Fangjian; Yang, Yang; Hu, Wei

doi:10.1155/2021/8873581

Cited by 23 publications

(24 citation statements)

References 132 publications

(188 reference statements)

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“…Also, cystatin C, a biomarker commonly used in practice could also predict postsurgery AKI ( https://www.ahajournals.org/doi/abs/10.1161/circ.136.suppl_1.21142 ; https://app.covidence.org/reviews/161933 ). 2 , 21 , 22 , 23 , 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

“…1 Risks for CPB-associated AKI have been classified as patient-related and procedure-related factors. 2 Procedure-related factors include systemic inflammatory response, anemia, oxygen delivery, coagulopathy subsequent to foreign surface exposure, and hemodilution associated with the use of a priming solution leading to renal vasoconstriction, and impaired oxygenation including the typically nonpulsatile flow used in CPB.…”

Section: Introductionmentioning

confidence: 99%

“… 1 Risks for CPB‐associated AKI have been classified as patient‐related and procedure‐related factors. 2 …”

Section: Introductionmentioning

confidence: 99%

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Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta‐analysis

Kandil

Motawea

Darling

et al. 2021

Clinical Cardiology

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Background: Cardiopulmonary bypass is known to raise the risk of acute kidney injury (AKI). Previous studies have identified numerous risk factors of cardiopulmonary bypass including the possible impact of perioperative ultrafiltration.However, the association between ultrafiltration (UF) and AKI remains conflicting.Thus, we conducted a meta-analysis to further examine the relationship between UF and AKI.Hypothesis: Ultrafiltration during cardiac surgery increases the risk of developping Acute kidney Injury.Methods: We searched PubMed, Web of Science, EBSCO, and SCOPUS through July 2021. The RevMan (version 5.4) software was used to calculate the pooled risk ratios (RRs) and mean differences along with their associated confidence intervals (95% CI). Results:We identified 12 studies with a total of 8005 patients. There was no statistically significant difference in the incidence of AKI between the group who underwent UF and the control group who did not (RR = 0.90, 95% CI = 0.64−1). Subgroup analysis on patients with previous renal insufficiency also yielded nonsignificant difference (RR = 0.84, 95% CI = 0.53 −1.33, p = .47). Subgroup analysis based on volume of ultrafiltrate removed (> or <2900 ml) was not significant and did not increase the AKI risk as predicted (RR = 0.82, 95% CI = 0.63 −1.07, p = .15). We also did subgroup analysis according to the type of UF and again no significant difference in AKI incidence between UF groups and controls was observed in either the conventional ultrafiltration (CUF), modified ultrafiltration (MUF), zero-balanced ultrafiltration (ZBUF), or combined MUF and CUF subgroups. Conclusion:UF in cardiac surgery is not associated with increased AKI incidence and may be safely used even in baseline chronic injury patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta‐analysis

Kandil

Motawea

Darling

et al. 2021

Clinical Cardiology

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“…hemodilator and decreased blood viscosity, hypothermia, and hypoperfusion seen during CPB cause a decrease in renal artery flow velocities and renal tubular injury [5,14,15]. Hemodynamic unstable processes, anemia, use of high blood products, and the need for inotropic agents in the early postoperative period are also important causes of AKI [5,15].…”

Section: Discussionmentioning

confidence: 99%

Is preoperative vitamin D level a risk factor for acute kidney injury developing after cardiopulmonary bypass?

Çelik¹,

Çora²,

Karadem

2022

Turkish Journal of Health Science and Life

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Objective: In this study, the relationship between acute kidney injury (AKI) that developed in the early postoperative period in the patients that underwent open heart surgery with cardiopulmonary bypass (CPB) and their preoperative 25-Hydroxy Vitamin D (25-OHD) levels was investigated. Method: 285 patients who underwent open heart surgery with CPB between February 2018 and December 2020 were retrospectively analyzed. Ninety seven patients (71 men, 26 women) who met the criteria were included in the study. The patients were divided into 3 groups according to their preoperative 25-OHD levels as deficiency (group I, n=28), insufficiency (group II, n=42) and normal (group III, n=27).Demographic and clinical characteristics, AKI, and CPB time were compared between the groups.Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were used to define postoperative AKI. Results: According to the KDIGO guidelines, the incidence of postoperative AKI decreased to 19% at the end of 48 hours and to 6.2% at discharge whereas it was 21% in the first 24 hours. The decrease in KDIGO AKI stages was found to be statistically significant (p=0.002). The rate of DM was found to be significantly higher in Group I (p=0.001). No statistical difference was found between AKI and 25-OHD levels at 24 hours, 48 hours and discharge. CPB time was found to be significantly higher in Group I (p=0.006). In the univariate logistic regression model created after 25-OHD groups were taken as low (group I+group II) and normal (group III), low 25-OHD levels were found to have a significant effect on the development of DM (p=0.001, OR:8.474, 95%CI 2.336 -30.303). Conclusion: Although we could not find a statistical relationship between AKI and preoperative 25-OHD levels in the patients that underwent open heart surgery with CPB, we believe that 25-OHD deficiency might have effects on postoperative morbidity and mortality by affecting the renocardiovascular system.

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“…Postoperative AKI results in poor outcomes, prolonged hospital length of stay (LOS), increased hospital costs and mortality 2 . The mechanism of AKI after cardiac surgery is tightly associated with the hemodynamic instability and sympathetic activity during cardiopulmonary bypass (CPB) [3][4][5] . Although numerous trials attempted to identify strategies to prevent AKI, the incidence is still around 40% and no definite strategy exists yet [6][7][8][9][10] .…”

mentioning

confidence: 99%

Does dexmedetomidine reduce the risk of acute kidney injury after cardiac surgery: a meta-analysis of randomized controlled trials

Zhao

Liu

Zhang

et al. 2021

Preprint

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OBJECTIVE: Acute kidney injury (AKI) is a common complication after cardiac surgery, and there is no pharmacologic prophylaxis of AKI. Some animal and clinical studies showed the renoprotection effect of dexmedetomidine (DEX) on AKI, but data from other trials came to the opposite conclusion following cardiac surgery. METHODS: We searched databases including EMBASE, PubMed, and Cochrane CENTRAL for randomized controlled trials (RCTs) focused on DEX for AKI in adult patients after cardiac surgery. The primary outcome was incidence of AKI. Secondary outcomes were mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay (LOS), hospital LOS and mortality. RESULTS: Fifteen trials enrolling 2907 study patients were collected in the meta-analyses. Compared with controls, DEX reduced the incidence of postoperative AKI [odds ratio (OR), 0.66; 95%confidence interval (CI), 0.48-0.91; P=0.01], and there was no significant difference between groups in postoperative mortality (OR, 0.63; 95%CI, 0.32-1.26; P=0.19), MV duration [weighted mean difference(WMD), -0.44; 95%CI, -1.50-0.63; P=0.42], ICU LOS (WMD, -1.19; 95%CI, -2.89-0.51; P=0.17) and hospital LOS (WMD, -0.31; 95%CI, -0.76-0.15; P=0.19). CONCLUSIONS: Perioperative DEX use reduced the incidence of postoperative AKI in adult patients undergoing cardiac surgery. No significant decrease existed in mortality, MV duration, ICU LOS and hospital LOS owing to the DEX administration.

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Acute Kidney Injury following Cardiopulmonary Bypass: A Challenging Picture

Cited by 23 publications

References 132 publications

Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta‐analysis

Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta‐analysis

Is preoperative vitamin D level a risk factor for acute kidney injury developing after cardiopulmonary bypass?

Does dexmedetomidine reduce the risk of acute kidney injury after cardiac surgery: a meta-analysis of randomized controlled trials

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