Incidence and outcomes of acute kidney injury after cardiac surgery using either criteria of the RIFLE classification

Abstract

BackgroundAdult cardiac surgery is significantly associated with the development of acute kidney injury (AKI). Still, the incidence and outcomes of AKI vary according to its definition. Our retrospective monocentric study comparatively investigates the yield of RIFLE definition, which is based on the elevation of serum creatinine levels (SCr) or the reduction of urine output (UO), taking into account only one or both criteria. Pre- and per-operative risk factors for post-operative AKI were evaluated.MethodsAll adult patients undergoing cardiac surgery, with or without cardiopulmonary bypass, from April 2008 to March 2009 were included. Clinical, biological and surgical features were recorded. Baseline serum creatinine was determined as its value on day 7 before surgery. Post-operative AKI was diagnosed and scored based upon the highest serum creatinine and/or the lowest urine output.Results443 patients (Male/Female ratio, 2.3; median age, 69y) were included, with 221 (49.9 %) developing postoperative AKI. Elevated serum creatinine (AKISCr) and oliguria (AKIUO) was observed in 9.7 % and 40.2 %, respectively. AKI patients had a significantly higher BMI and baseline SCr. In comparison to AKIUO, AKISCr mostly occurred in patients with co-morbidities, and was associated with an increased mortality at 1-year post surgery.ConclusionsThe use of standard RIFLE definition of AKI in a cohort of 443 patients undergoing cardiac surgery resulted in an incidence reaching 50 %. Still, significant discrepancies were found between AKISCr and AKIUO regarding the incidence and outcomes. In line with previous reports, our data questions the utility of urine output as a criterion for AKI diagnosis and management after cardiac surgery.

Mitral and aortic valve surgery-related acute kidney injury: affecting factors and its one year follow-up

“…[3] Patients with AKI in the postoperative period have a higher infection and sepsis rate with longer intensive care unit stay and higher mortality rate, while they need more intra-aortic balloon pump and inotropic support. [19,[22][23][24][25] Consistent with the previous findings, we found higher sepsis and postoperative atrial fibrillation rates in AKI (+) patients. Our patients with AKI also needed more intra-aortic balloon pump and renal replacement therapy during the postoperative course.…”

Role of Body Mass Index in Acute Kidney Injury Patients after Cardiac Surgery

“…Acute kidney injury (AKI) is a common and serious complication of cardiac surgery; AKI has been reported to occur in 5-50% of hospitalized patients undergoing cardiac surgery based on different definitions of AKI [1,2,3]. AKI after cardiac surgery (CS-AKI) patients have higher mortality rates than those who did not develop AKI [4,5], and the mortality rate of AKI-renal replacement therapy (AKI-RRT) patients has been reported to be 41.4-65% [6,7,8,9].…”

Incidencia acumulada de insuficiencia renal aguda en el posoperatorio de cirugía cardíaca

“…En la tabla 1 se resume el criterio de clasificación RIFLE. No se consideró el criterio de diuresis, que si bien está incluido en la definición, en el POCC el manejo de fluidos varía ampliamente según las características del paciente y el tipo de cirugía (20) .…”