Cardiac surgery-associated acute kidney injury: pathophysiology and diagnostic modalities and management

Leballo, Gontse; Chakane, Palesa Motshabi

doi:10.5830/cvja-2019-069

Cited by 11 publications

(12 citation statements)

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“…CSA-AKI is the second most common cause of AKI for critically ill patients (followed by sepsis) and is significantly associated with increased mortality, prolonged length of hospital stays and increased health-care cost. [21][22][23] In the current study, the rate of postoperative AKI in ICU patients with cardiac surgery is 72.0%, which is higher than previous studies for hospitalized patients in general ward. 24,25 Hence, a novel biomarker that could identify patients at high risk of AKI after cardiac surgery earlier might lead to better clinical outcomes and lower hospital expenses.…”

Section: Discussioncontrasting

confidence: 67%

Preoperative Glucose-to-Lymphocyte Ratio is an Independent Predictor for Acute Kidney Injury After Cardiac Surgery in Patients in Intensive Care Unit

Li¹,

Zou²

2021

IJGM

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Background:We aimed to investigate the association between preoperative glucose-tolymphocyte ratio (GLR) and cardiac surgery associated with acute kidney injury (CSA-AKI) in patients in the intensive care unit (ICU). Methods: The Medical Information Mart for Intensive Care IV (MIMIC-IV version 1.0) database was used to identify adults' patients who performed cardiac surgery during ICU stay. The primary outcome was the development of AKI based on the KDIGO criteria. Multivariable logistic regression was applied to investigate the association between GLR and clinical outcomes, and propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were also used to validate our findings. Results: The optimal cut-off value for GLR was 1.28. Among the 7181 patients who conducted cardiac surgery, 2072 high-GLR group (≥1.28) patients and 2072 low-GLR group (<1.28) patients, had similar propensity scores were included in this study. After matching, the high-GLR group had a significantly higher incidence of AKI (odds ratio, OR, 3.28, 95% confidence index, 95% CI, 2.81-3.84, P <0.001) even after adjustment for confounding factors. Moreover, the performance of GLR was superior to that of SOFA scores and GLR plus clinical model could add more net benefit for CSA-AKI than clinical model alone. Conclusion:Preoperative GLR could serve as a good predictor for CSA-AKI in patients in ICU.

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Section: Discussioncontrasting

confidence: 67%

Preoperative Glucose-to-Lymphocyte Ratio is an Independent Predictor for Acute Kidney Injury After Cardiac Surgery in Patients in Intensive Care Unit

Li¹,

Zou²

2021

IJGM

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“…AKI and its detrimental peri-operative effects during mitral valve surgery have been extensively reviewed. (6,16,17) Patients undergoing mitral valve surgery commonly display a decrease in the volume of blood ejected from the mitral valve due to regurgitation, resulting in poor perfusion to the kidneys. A third of patients who underwent mitral valve surgery developed AKI, (18) and patients presenting with AKI had increased prevalence of hypertension and diabetes.…”

Section: Outcomes Of Mitral Valve Surgery 122mentioning

confidence: 99%

“…Volume 18 Number 2 bypass (CPB). (6) Platelets are activated and subsequently bind to the exposed subendothelium, the CPB circuit or to the circulating monocytes and neutrophils, resulting in a decrease in platelet numbers. (7) The decrease in platelet numbers and altered platelet function is the rationale behind the major blood loss encountered during cardiac surgery.…”

mentioning

confidence: 99%

“…(16) AKI develops in 2.8% of patients following valvular heart surgery. (6,17) In one study, 38.7% of patients who underwent mitral valve surgery had postoperative AKI, and presented with pre-operative New York Heart Association (NYHA) functional class III and IV, a dilated left ventricle (LV) and low LV ejection fraction (LVEF), all of which lead to hypoperfusion of the kidneys and AKI. (18) AKI prolongs hospital stay and increases the risk of infectious complications and mortality.…”

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confidence: 99%

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Peri-operative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital

Tabane¹,

Leonard²,

Kleyenstuber³

2021

SAHJ

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Distribution and determinants of heart disease vary greatly between high-income countries and sub-Saharan Africa where rheumatic heart disease (RHD) is a major public health challenge. (1) RHD is the predominant cause of valve disease in Africa, (2) resulting in Africa having the highest prevalence of cardiac disease in children and young adults .(1) Cumulative effects of poverty, social instability and lack of infrastructure, resources and awareness contribute to the underestimated impact of RHD. (1,2) Studies from Africa confirm that RHD is the main cause of cardiac morbidity and mortality from heart surgery. (1)(2)(3) Mitral valve disease, in the form of mitral stenosis and mitral regurgitation, is the commonest form of valve disease and its treatment usually involves surgical repair or replacement. These surgical procedures are highly invasive and not without risk of complications. (3) In South Africa, data on the management and outcomes of mitral valve surgery are limited. (4) Operative mortality in mitral valve replacement surgery is 5% -6% and 1% -2% in mitral valve repair. (5) Complications associated with mitral valve surgery are commonly related to cardiopulmonary

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“…Acute kidney (renal) injury (AKI) is a severe and common complication that occurs in ~40% of patients undergoing cardiac surgery. AKI has been associated with increased mortality, worse prognosis, more days of mechanical ventilation, a higher inotropic requirement, and a longer length of stay [Meersch 2017;Calderon-Rojas 2020;Leballo 2020]. We hypothesized that improvement in prevention and treatment of AKI after pericardiectomy can decrease operative mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury: Lessons from Pericardiectomy

Wen

et al. 2021

HSF

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Background: Acute kidney (renal) injury (AKI) is a severe and common complication that occurs in ~40% of patients undergoing cardiac surgery. AKI has been associated with increased mortality and worse prognosis. This prospective study was conducted to determine the risk factors for AKI after pericardiectomy and decrease the operative risk of mortality and morbidity. Methods: This was a prospective, observational cohort study of patients with constrictive pericarditis undergoing pericardiectomy. All patients underwent pericardiectomy via median sternotomy. Serum creatinine was used as the diagnostic standard of AKI according to Kidney Disease Improving Global Outcomes classification. All survivors were monitored to the end date of the study. Results: Consecutive patients (N = 92) undergoing pericardiectomy were divided into 2 groups: with AKI (n = 25) and without AKI (n = 67). The incidence of postoperative AKI was 27.2% (25/92). Hemodialysis was required for 10 patients (40%), and there were 5 operative deaths. Mortality, intubation time, time in intensive care unit, fresh-frozen plasma, and packed red cells of the group with AKI were significantly higher than those of the group without AKI. Both univariate and multivariate analyses showed that statistically significant independent predictors of AKI include intubation time, chest drainage, fresh-frozen plasma, and packed red cells. The latest follow-up data showed that 85 survivors were New York Heart Association class I (97.7%) and 2 were class II (2.3%). Conclusions: AKI after pericardiectomy is a serious complication and contributes to significantly increased morbidity and mortality. Prevention of AKI development after cardiac surgery and optimization of pre-, peri-, and postoperative factors that can reduce AKI, therefore, contribute to a better postoperative outcome and leads to lower rates of AKI, morbidity, and mortality.

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Cardiac surgery-associated acute kidney injury: pathophysiology and diagnostic modalities and management

Cited by 11 publications

References 0 publications

Preoperative Glucose-to-Lymphocyte Ratio is an Independent Predictor for Acute Kidney Injury After Cardiac Surgery in Patients in Intensive Care Unit

Preoperative Glucose-to-Lymphocyte Ratio is an Independent Predictor for Acute Kidney Injury After Cardiac Surgery in Patients in Intensive Care Unit

Peri-operative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital

Acute Kidney Injury: Lessons from Pericardiectomy

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