Predictors of acute renal failure requiring renal replacement therapy post cardiac surgery in patients with preoperatively normal renal function

Abstract

Acute renal failure requiring continuous renal replacement therapy post cardiac surgery carries a high mortality. Most studies have focused on patients with impaired renal function preoperatively but little is known about predictors of such a complication in patients with preoperatively normal renal function. This is a retrospective review of a prospective collected database. A total of 1609 patients underwent cardiac surgery over a 4-year period. Dialysis was required in 47 patients (2.9%). Univariate analysis identified the following as significant risk factors: age, female gender, chronic obstructive pulmonary disease, congestive cardiac failure, creatinine clearance, Euro, Parsonnet and Cleveland clinic scores, body mass index, non-isolated CABG, cardiopulmonary bypass time, extubation time and pulmonary complications (P<0.05). Multivariate analysis identified EuroSCORE, congestive cardiac failure, insulin-dependent diabetes, emergency surgery, postoperative extubation time and pulmonary complications as independent risk factors (P<0.05). In-hospital mortality and length of stay (P<0.0001) were higher in dialysis group. Acute renal failure requiring dialysis post cardiac surgery is associated with a higher mortality and prolonged hospital stay. By identifying higher risk patients, early planned preventative measures should be readily available to both reduce the incidence of such a complication and improve utilisation of hospital resources.

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

“…The metrics most commonly used to define AKI are the absolute or relative serum creatinine level and/or the need for dialysis in previously undialyzed patients. Table 1 [1,2,3,4,8,11,12,13,14,15,16,17,18] shows the range of metrics used in recent studies involving cardiac surgery patients and the corresponding incidence of AKI. Attempts to promote the use of consistent criteria for the definition of AKI resulted in the publication of the Acute Dialysis Quality Initiative Group’s Risk, Injury, Failure, Loss of Kidney Function, End-Stage Kidney Disease criteria, which were subsequently modified to create the Acute Kidney Injury Network criteria [19,20].…”

“…Mortality rates range from 18 to almost 80% in those who develop this condition, and from 0.9 to 6.4% in those who do not (table 1) [1,2,3,4,8,11,12,13,14,15,16,17,18]. As a result, the OR for death associated with postoperative AKI is in the range of 34–39 [13,18]. In cardiac surgery patients, postoperative AKI is also associated with longer intensive care unit and hospital stays [11,15,18,20] and, among survivors, with the need for permanent dialysis [1,16].…”

“…As a result, the OR for death associated with postoperative AKI is in the range of 34–39 [13,18]. In cardiac surgery patients, postoperative AKI is also associated with longer intensive care unit and hospital stays [11,15,18,20] and, among survivors, with the need for permanent dialysis [1,16]. Discharge to a care facility, rather than discharge home, is also significantly more common in patients who have experienced postoperative renal failure [15].…”

Predicting Hospital-Acquired Acute Kidney Injury—A Case-Controlled Study

“…These potential predictor variables were chosen either because they have been shown to be risk factors for HAKI in previous work in intensive care unit and cardiac surgery patients or because of biological plausibility. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] …”

“…[6][7][8][9][10][11][12][13] In cardiac surgery patients, age, diabetes, elevated creatinine, low albumin, prolonged use of cardiopulmonary bypass, and emergency surgery have been shown to be risk factors for post-operative HAKI. [14][15][16][17][18][19][20][21][22][23][24] There has been no study examining the risk factors for the development of HAKI among the general hospitalized population. Understanding the risk factors for HAKI that are present on admission would allow clinicians to more carefully manage high-risk individuals and allow researchers to focus interventional studies on high-risk groups.…”