Duration of Acute Kidney Injury Impacts Long-Term Survival After Cardiac Surgery

Brown, Jeremiah R.; Kramer, Robert S.; Coca, Steven G.; Parikh, Chirag R.

doi:10.1016/j.athoracsur.2010.04.039

Cited by 282 publications

(237 citation statements)

References 23 publications

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“…Regardless of disease severity, these studies demonstrate that complete and sustained reversal of an AKI episode within 48-72 h of its onset is associated with better outcomes than longer durations of AKI [10][11][12][13][14][15] . Based on the available data and expert opinion, the workgroup proposes using 48 h to define rapid reversal of AKI…”

Section: Persistent Aki Transient Versus Persistent Akimentioning

confidence: 76%

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

et al. 2017

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Section: Persistent Aki Transient Versus Persistent Akimentioning

confidence: 76%

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

et al. 2017

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“…CPB-AKI has been consistently shown to increase both morbidity (4) and mortality (5). Likewise, AKI may also affect quality of life (6) and has an effect on mortality beyond the perioperative period (7).…”

Section: Introductionmentioning

confidence: 99%

Follow-Up Renal Assessment of Injury Long-Term After Acute Kidney Injury (FRAIL-AKI)

Cooper

Claes

Goldstein

et al. 2016

Clinical Journal of the American Society of Nephrology

116

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Background and objectives Novel urinary kidney damage biomarkers detect AKI after cardiac surgery using cardiopulmonary bypass (CPB-AKI). Although there is growing focus on whether AKI leads to CKD, no studies have assessed whether novel urinary biomarkers remain elevated long term after CPB-AKI. We assessed whether there was clinical or biomarker evidence of long-term kidney injury in patients with CPB-AKI.Design, setting, participants, & measurements We performed a cross-sectional evaluation for signs of chronic kidney injury using both traditional measures and novel urinary biomarkers in a population of 372 potentially eligible children (119 AKI positive and 253 AKI negative) who underwent surgery using cardiopulmonary bypass for congenital heart disease at Cincinnati Children's Hospital Medical Center between 2004 and 2007. A total of 51 patients (33 AKI positive and 18 AKI negative) agreed to long-term assessment. We also compared the urinary biomarker levels in these 51 patients with those in healthy controls of similar age.Results At long-term follow-up (mean duration6SD, 760.98 years), AKI-positive and AKI-negative patients had similarly normal assessments of kidney function by eGFR, proteinuria, and BP measurement. However, AKI-positive patients had higher urine concentrations of IL-18 (48.5 pg/ml versus 20.3 pg/ml [P=0.01] and 20.5 pg/ml [P,0.001]) and liver-type fatty acid-binding protein (L-FABP) (5.9 ng/ml versus 3.9 ng/ml [P=0.001] and 3.2 ng/ml [P,0.001]) than did AKI-negative patients and healthy controls.Conclusions Novel urinary biomarkers remain elevated 7 years after an episode of CPB-AKI in children. However, there is no conventional evidence of CKD in these children. These biomarkers may be a more sensitive marker of chronic kidney injury after CPB-AKI. Future studies are needed to understand the clinical relevance of persistent elevations in IL-18, kidney injury molecule-1, and L-FABP in assessments for potential long-term kidney consequences of CPB-AKI.

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“…3,4 These definitions have aided in ascertainment of the true incidence of AKI after cardiac surgery and shown that AKI, regardless of severity or stage, is associated with longer length of intensive care unit (ICU) and hospital stay, increased cost of hospitalization, and increased patient mortality. 5,6 In recent years, several studies have shown that novel biomarkers can detect acute tubular injury earlier than serum creatinine in the setting of AKI. [7][8][9][10][11] Despite attempts to select patients at high risk for severe AKI, the majority of patients in these prospective studies do not develop clinical AKI.…”

mentioning

confidence: 99%

Biomarkers Predict Progression of Acute Kidney Injury after Cardiac Surgery

Koyner

Garg

Coca

et al. 2012

Journal of the American Society of Nephrology

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255

218

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Being able to predict whether AKI will progress could improve monitoring and care, guide patient counseling, and assist with enrollment into trials of AKI treatment. Using samples from the Translational Research Investigating Biomarker Endpoints in AKI study (TRIBE-AKI), we evaluated whether kidney injury biomarkers measured at the time of first clinical diagnosis of early AKI after cardiac surgery can forecast AKI severity. Biomarkers included urinary IL-18, urinary albumin to creatinine ratio (ACR), and urinary and plasma neutrophil gelatinaseassociated lipocalin (NGAL); each measurement was on the day of AKI diagnosis in 380 patients who developed at least AKI Network (AKIN) stage 1 AKI. The primary end point (progression of AKI defined by worsening AKIN stage) occurred in 45 (11.8%) patients. Using multivariable logistic regression, we determined the risk of AKI progression. After adjustment for clinical predictors, compared with biomarker values in the lowest two quintiles, the highest quintiles of three biomarkers remained associated with AKI progression: IL-18 (odds ratio=3.0, 95% confidence interval=1.3-7.3), ACR (odds ratio=3.4, 95% confidence interval=1.3-9.1), and plasma NGAL (odds ratio=7.7, 95% confidence interval=2.6-22.5). Each biomarker improved risk classification compared with the clinical model alone, with plasma NGAL performing the best (category-free net reclassification improvement of 0.69, P,0.0001). In conclusion, biomarkers measured on the day of AKI diagnosis improve risk stratification and identify patients at higher risk for progression of AKI and worse patient outcomes.

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Duration of Acute Kidney Injury Impacts Long-Term Survival After Cardiac Surgery

Abstract: Background-Acute kidney injury (AKI) following cardiac surgery is associated with worse outcomes. However, it is not known how adverse long-term consequences vary according to the duration of AKI. We sought to determine the association between duration of AKI and survival.

Cited by 282 publications

References 23 publications

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Follow-Up Renal Assessment of Injury Long-Term After Acute Kidney Injury (FRAIL-AKI)

Biomarkers Predict Progression of Acute Kidney Injury after Cardiac Surgery

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