Factors associated with acute kidney injury and mortality during cardiac surgery

Leballo, Gontse; Moutlana, Hlamatsi Jacob; Muteba, Michel; Chakane, Palesa Motshabi

doi:10.5830/cvja-2020-063

Cited by 14 publications

(15 citation statements)

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“…The reverse of increased activity of urine enzymes could be explained that the patients are carefully monitored and treated during the first few days after cardiac procedures. 1 , 3 , 4 Up to date, there is no validated cut-off point for discrimination of clinically significant tubular damage during intraoperative or early postoperative periods in adults. While AURoC values look impressive, applying levels of urinary or serum biomarkers for discrimination in individual patients is disappointing by a wide overlap between groups and false positive results as consequences.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…1,2 The patients who survive CSA-AKI have a greater risk of developing chronic kidney disease or end stage renal disease compared to patients without AKI and about 2% to 5% of them patients require renal replacement therapy. 3,4 During cardiac surgery performed with cardio-pulmonary bypass (CPB) the time of kidney injury is predictable and usually occurs secondary to the unique characteristics of cardiac procedures. The pathomechanism of AKI is complex and caused by an interplay between patient susceptibility to injury and many additional factors.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Consequences of Increased Activity of Urine Enzymes After Cardiac Surgery – A Prospective Observational Study

Biernawska¹,

Kotfis²,

Szymańska-Pasternak³

et al. 2022

TCRM

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Introduction Cardiac surgery associated AKI (CSA-AKI) complicates recovery and may be associated with a greater risk of developing chronic kidney disease and mortality. The aim of this study was to assess long-term clinical consequences of transient increased activity of urinary enzymes after cardiac surgery (CS). Methods An observational study was conducted in a group of 88 adult patients undergoing planned coronary artery bypass grafting (CABG), but all samples were obtained from 79 patients. The activity of urinary enzymes: N-acetyl-beta-glucosaminidase (NAG), arylsulfatase A (ASA) and beta-glucuronidase was evaluated in sequential urine samples. A comparative analysis of biochemical parameters was performed regarding the occurrence of acute kidney injury (AKI) defined by KIDGO at 24 hours, at day 30 and 5-years after the operation. Results During the first 24 hours after CS AKI was diagnosed in 13 patients. A comparison of the activity of urinary enzymes in pre-defined time-points showed significant differences for ASA and NAG (post OP-sample p < 0.028 and p < 0.022; POD 1 sample p < 0.004 and p < 0.001 respectively). No patient had any biochemical or clinical features of kidney failure at day 30. In the AKI group kidney failure was diagnosed in 36% of patients within 5 years of follow-up as opposed to 5% in the no AKI group. The activities of tubular enzymes in urine reflect a general injury of kidney tubules during and after the operation. However, they are not ideal biomarkers for prediction of the degree of kidney injury and further poor prognosis of CS-AKI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Consequences of Increased Activity of Urine Enzymes After Cardiac Surgery – A Prospective Observational Study

Biernawska¹,

Kotfis²,

Szymańska-Pasternak³

et al. 2022

TCRM

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“…In surgical patients, postoperative AKI has been studied at length in cardiac and vascular procedures. [7] In recent years, an increasing number of studies has focused on postoperative AKI in other surgical groups, such as major abdominal procedures. [8][9][10] However, limited literature is available from sub-Saharan Africa on AKI in the non-cardiac, nonvascular surgical population.…”

mentioning

confidence: 99%

“…[11] South African (SA) studies on AKI have predominantly focused on medical patients. Local literature includes studies on hospitalised patients (predominantly medical), [3] HIV-positive patients, [12] COVID-19 patients, [13] post-cardiac surgery patients, [7] medically and surgically managed trauma patients [14] and critically ill patients. [15,16] However, there is a paucity of local literature on non-cardiac post-surgical AKI studies.Developing countries, such as SA, often have different patient characteristics compared with patients studied in the developed world.…”

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confidence: 99%

Acute kidney injury after major non-cardiac surgery: Incidence and risk factors

Rossouw

Chetty²

2023

S Afr Med J

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Background. Acute kidney injury (AKI) is a major post-surgical complication that contributes to morbidity and mortality. AKI is welldocumented after cardiac surgery. However, less is known regarding the incidence and risk factors following major non-cardiac surgery.Globally the incidence of AKI post major surgery has been evaluated; however, there are no data available for South Africa (SA).Objectives. To ascertain the incidence of AKI after major non-cardiac surgery at a tertiary academic SA hospital. Secondary outcomes wereto identify perioperative risk factors that are associated with an elevated risk to develop AKI in the postoperative period.Methods. The study was conducted at Tygerberg Hospital, a single tertiary centre in Cape Town, SA. Perioperative records of adults whounderwent major non-cardiac surgery were retrospectively collected. Variables pertaining to potential risk factors for AKI were captured,and serum creatinine levels were recorded up to 7 days postoperatively and compared with baseline measurements to determine whetherAKI had developed. Descriptive statistics along with logistic regression analysis were used to interpret results.Results. The overall incidence of AKI was 11.2% (95% confidence interval (CI) 9.8 - 12.6). Based on surgical discipline, trauma surgery(19%), followed by abdominal (18.5%) and vascular surgery (17%) had the highest incidence. Independent AKI risk factors wereidentified after multivariate analysis. These were: chronic obstructive pulmonary disease (odds ratio (OR) 2.19; 95% CI 1.09 - 4.37;p=0.005), trauma surgery (OR 3.00; 95% CI 1.59 - 5.64; p=0.001), abdominal surgery (OR 2.14; 95% CI 1.33 - 3.45; p=0.002), vascularsurgery (OR 2.42; 95% CI 1.31 - 4.45; p=0.004), urology procedures (OR 2.45; 95% CI 1.31 - 4.45; p=0.005), red blood cell transfusion(OR 1.81; 95% CI 1.21 - 2.70; p=0.004), emergency surgery (OR 1.74; 95% CI 1.15 - 2.65; p=0.009) and inotrope use (OR 2.77; 95% CI1.80 - 4.26; p<0.001).Conclusion. The results of our study are in keeping with international literature regarding the incidence of AKI after major non-cardiacsurgery. The risk factor profile, however, is in several regards different from what has been found elsewhere

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Association between the intraoperative fluid balance during cardiac surgery and postoperative sequential organ failure assessment score: a post hoc analysis of the BROTHER study, a retrospective multicenter cohort study

Koga,

Yoshida,

Kotani

et al. 2023

Heart Vessels

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Factors associated with acute kidney injury and mortality during cardiac surgery

Cited by 14 publications

References 0 publications

Long-Term Consequences of Increased Activity of Urine Enzymes After Cardiac Surgery – A Prospective Observational Study

Long-Term Consequences of Increased Activity of Urine Enzymes After Cardiac Surgery – A Prospective Observational Study

Acute kidney injury after major non-cardiac surgery: Incidence and risk factors

Association between the intraoperative fluid balance during cardiac surgery and postoperative sequential organ failure assessment score: a post hoc analysis of the BROTHER study, a retrospective multicenter cohort study

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