Incidence, dynamics, and prognostic value of acute kidney injury for death after cardiac surgery

Dardashti, Alain; Ederoth, Per; Algotsson, Lars; Brondén, Björn; Bjursten, Henrik

doi:10.1016/j.jtcvs.2013.07.073

Cited by 74 publications

(45 citation statements)

References 33 publications

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“…We excluded 268 studies: animal studies (15), reviews (42), no epidemiological data available (177), not about CRS-1 (23), no data about AKI or WRF (8) and studies evaluating a specific intervention (3). Finally, we included 64 papers (n = 509,766 patients), containing data on AKI in AHF patients (18 studies; 29,202 patients) [4,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26], ACS (15 studies; 282,113 patients) [13,27,28,29,30,31,32,33,34,35,36,37,38,39,40] and CS (32 studies; 198,451 patients) [41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72] (table 1). One study contained information about AHF as well as ACS and is therefore used in both groups [13].…”

Section: Resultsmentioning

confidence: 99%

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Vandenberghe¹,

et al. 2015

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Background: We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). Summary: We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOS_ICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOS_hosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOS_ICU = 10.6 days and that of LOS_hosp = 20.2 days). Key Messages: Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.

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Section: Resultsmentioning

confidence: 99%

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Vandenberghe¹,

et al. 2015

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“…Several studies have investigated the strong impact of renal failure after cardiac surgery on postoperative morbidity and mortality. 1,2,17 Leacche et al 17 investigated 13,847 patients who underwent cardiac surgery and reported that of patients requiring RRT, 64% required permanent dialysis, and the 1-year survival rate was only 10%. Rydén et al 18 recently performed a nationwide population-based cohort study in 27,929 patients who underwent CABG in Sweden and showed that postoperative acute renal failure was associated with increased long-term risk for myocardial infarction and death.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Previously reported preoperative risk factors for postoperative acute renal dysfunction requiring transient or permanent RRT included age, 3,4 female gender, 3,5 preoperative heart failure, 2,3 diabetes, 5 hypertension, 6 anemia, 7 cardiopulmonary bypass (CPB) use, 8,9 and preexisting renal dysfunction, 2,4e6 especially in patients who undergo emergency surgery under unstable conditions. 3,4,7 However, the factors associated with RRT in patients who undergo elective cardiac surgery in stable condition have not been fully evaluated.…”

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confidence: 99%

Preoperative Factors Associated With Postoperative Requirements of Renal Replacement Therapy Following Cardiac Surgery

Sato

Kato

Oishi

et al. 2015

The American Journal of Cardiology

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“…Previousstudies (2,3) revealed that even a mild increase in serum creatinine levels following cardiac surgery is associated with progression of chronic kidney disease and increased mortality. CSA-AKI is a common and severe complication in patients undergoing cardiac surgery and is associated with poor outcomes (4-6)…”

Section: Introductionmentioning

confidence: 99%

Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study

Xie

Wan

et al. 2017

Intern. Med.

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Objective To evaluate the incidence, risk, or protective factors of acute kidney injury (AKI) in patients after cardiac surgery based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Methods A retrospective analysis of 2,575 patients undergoing their first documented cardiac surgery with cardiopulmonary bypass (CPB) was conducted. Perioperative variables were collected and analyzed. Univariate and multiple logistic regression models were used for determining the association between the development of AKI and risk factors. Multiple Cox-proportional hazards modeling was performed to evaluate the impact of AKI on the mortality in the intensive care unit and hospital length of stay. Results Of 2,575 patients, 931 (36%) developed AKI. A total of 30 (1.2%) patients required renal replacement therapy. In the multivariate analysis, mechanical ventilation duration (OR1.446, 95% CI 1.195-1.749, p<0.001), CPB duration of ≥110 min (OR 1.314, 95% CI 1.072-1.611, p=0.009), erythrocytes transfusion (OR 1.078, 95% CI 1.050-1.106, p<0.001), and postoperative body temperature greater than 38℃ within 3 days (OR 1.234, 95% CI 1.018-1.496, p=0.032) were independent risk factors for CSA-AKI, while ulinastatin use was associated with a reduced incidence of CSA-AKI (OR 0.694, 95% CI 0.557-0.881, p=0.006). CSA-AKI was significantly associated with in-hospital mortality (adjusted HR: 2.218, 95% CI 1.161-4.238, p=0.016), especially in patients needing renal replacement therapy (adjusted HR: 18.683, 95% CI 8.579-40.684, p<0.001). Conclusion Mechanical ventilation duration, erythrocytes transfusion, and postoperative body temperature above 38℃ within 3 days were considered independent risk factors for CSA-AKI. The use of ulinastatin was associated with a reduced incidence of CSA-AKI.

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Incidence, dynamics, and prognostic value of acute kidney injury for death after cardiac surgery

Cited by 74 publications

References 33 publications

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Preoperative Factors Associated With Postoperative Requirements of Renal Replacement Therapy Following Cardiac Surgery

Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study

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