Chronic progression of cardiac surgery associated acute kidney injury: Intermediary role of acute kidney disease

Cho, Jin Sun; Shim, Jæ Kwang; Lee, Sak; Song, Jong Wook; Choi, Nakcheol; Lee, Sugeun; Kwak, Young Lan

doi:10.1016/j.jtcvs.2019.10.101

Cited by 44 publications

(33 citation statements)

References 34 publications

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“…Patients not meeting criteria for CKD after the period of AKD will be described as having a history of AKD and are at increased risk for new onset of CKD. 5,11,13,14,16,22 Figure 5 describes numerous possible trajectories, based on data from patients in various settings. 23 Previously, clinicians have viewed AKI as a discrete event that either resolves or reaches a new steady state before 3 months.…”

Section: Definition and Staging For Akdmentioning

confidence: 99%

See 1 more Smart Citation

Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference

Lameire

Levin

Kellum

et al. 2021

Kidney International

275

132

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Section: Definition and Staging For Akdmentioning

confidence: 99%

“…(Table 1). [9][10][11][12][13][14][15][16][17][18][19] Studies were perforce retrospective with reported outcomes mainly confined to mortality and incident CKD, and periods of follow-up ranging from 90 days to 10 years. What these studies confirm are increased risks of both mortality and incident CKD associated with AKD.…”

Section: Introductionmentioning

confidence: 99%

Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference

Lameire

Levin

Kellum

et al. 2021

Kidney International

275

132

View full text Add to dashboard Cite

“…However, the prognosis of severe AKI is even worse, as mortality increases sharply with more advanced stages of AKI [ 3 ]. Furthermore, AKI severity is associated with incremental risk of progression to chronic kidney disease [ 4 ]. As there are no proven remedies to treat AKI, strategies to prevent it and alleviate its severity are crucial.…”

Section: Introductionmentioning

confidence: 99%

High Preoperative Serum Syndecan-1, a Marker of Endothelial Glycocalyx Degradation, and Severe Acute Kidney Injury after Valvular Heart Surgery

Kim

Soh

Kwak

et al. 2020

JCM

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Degradation of endothelial glycocalyx (EG) is associated with inflammation and endothelial dysfunction, which may contribute to the development of acute kidney injury (AKI). We investigated the association between a marker of EG degradation and AKI after valvular heart surgery. Serum syndecan-1 concentrations were measured at induction of anesthesia and discontinuation of cardiopulmonary bypass in 250 patients. Severe AKI was defined as Kidney Disease: Improving Global Outcomes Criteria Stage 2 or 3. Severe AKI occurred in 13 patients (5%). Receiver operating characteristic analysis of preoperative syndecan-1 to predict severe AKI showed area under curve of 0.714 (95% confidence interval (CI), 0.575–0.853; p = 0.009). The optimal cut-off value was 90 ng/mL, with a sensitivity of 61.5% and specificity of 78.5%. In multivariable analysis, both preoperative syndecan-1 ≥ 90 ng/mL and Cleveland Clinic Foundation score independently predicted severe AKI. Severe tricuspid regurgitation was more frequent (42.4% vs. 17.8%, p < 0.001), and baseline right ventricular systolic pressure (41 (33–51) mmHg vs. 33 (27–43) mmHg, p = 0.001) and TNF-α (1.85 (1.37–2.43) pg/mL vs. 1.45 (1.14–1.92) pg/mL, p <0.001) were higher in patients with high preoperative syndecan-1. Patients with high preoperative syndecan-1 had longer hospital stay (16 (12–24) days vs. 13 (11–17) days, p = 0.001). In conclusion, a high preoperative syndecan-1 concentration greater than 90 ng/mL was able to predict severe AKI after valvular heart surgery and was associated with prolonged hospitalization.

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“…Others have similarly demonstrated that any perioperative kidney injury, no matter how minor, and despite its apparent complete resolution during the index hospitalization as determined by a normalized SCr, significantly increases postoperative morbidity and mortality. 2 Stage 1 AKI has also been independently associated with infection following cardiac surgery. 3 Given the appreciable renal functional reserve, even a small increase in SCr does not occur before 50% of the renal glomerular filtration capacity is impaired.…”

mentioning

confidence: 99%

Commentary: A little is way too much: What we have learned about perioperative acute kidney injury

Engelman¹,

Schwann²

2021

The Journal of Thoracic and Cardiovascular Surgery

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In this issue of the Journal, Priyanka and colleagues, 1 in an innovative analysis, raise awareness of the significant and hereto-underappreciated risk of acute kidney injury (AKI) following cardiac surgery. They analyzed the rates of AKI in a large multihospital cohort of 6637 patients undergoing cardiac surgery. 1 They examined the relationship between The Kidney Disease: Improving Global Outcomes (KDIGO) AKI stage, defined by either serum creatinine (SCr) elevation and/or urine output criteria and the rates of subsequent major adverse kidney events (MAKE) at 180 days. In this study, KDIGO AKI occurred in a staggering 81% of patients-stage 1: 21%, stage 2: 49%, and stage 3: 12%. In stark contrast, the Society of Thoracic Surgeons (STS) database reportable AKI rate occurred in only 4%, thus giving clinicians a false sense of security and accomplishment. Most impressively, patients with stage 3 AKI had a 61.3% incidence of MAKE and a 33.3% mortality by 180 days. Importantly, even patients with stage 1 AKI had a 14.9% MAKE and 6.6% mortality compared with patients with no AKI who had a 4.5% MAKE and 2.2% mortality by 180 days.

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Chronic progression of cardiac surgery associated acute kidney injury: Intermediary role of acute kidney disease

Cited by 44 publications

References 34 publications

Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference

Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference

High Preoperative Serum Syndecan-1, a Marker of Endothelial Glycocalyx Degradation, and Severe Acute Kidney Injury after Valvular Heart Surgery

Commentary: A little is way too much: What we have learned about perioperative acute kidney injury

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