Prognostic Value of Acute Kidney Injury after Cardiac Surgery according to Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO) Criteria

Machado, Maurício de Nassau; Nakazone, Marcelo Arruda; Maia, Lília Nigro

doi:10.1371/journal.pone.0098028

Cited by 138 publications

(103 citation statements)

References 36 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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“…Acute kidney injury (AKI) is a common postoperative complication after surgical or percutaneous coronary revascularization, occurring in up to 45% of cases, depending on the definition of AKI used [1,2,3,4,5]. Severe AKI requiring renal replacement therapy (RRT) is reported in <1% of patients after percutaneous coronary intervention (PCI) [5,6] and in 2-6% patients after coronary artery bypass graft (CABG) [1,2,7].…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study

Shen

Aguilar

Montero³

et al. 2017

Am J Nephrol

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Background: Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. Methods: We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups. Results: The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges. Conclusions: Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.

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“…(21) Scientific evidence identified acute kidney injury incidences of 14 and 51% using the KDIGO classification system. (22,23) However, in this study, more than half of patients developed acute kidney injury after cardiac surgery. Among other factors, this is because the classification enables the identification of acute kidney injury in the first two days after renal insult.…”

Section: Discussionmentioning

confidence: 63%

Lesão renal aguda no pós-operatório de cirurgia cardíaca

Nascimento

Aguiar²,

Silva

et al. 2015

Acta paul. enferm.

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Objective: To identify the occurrence of acute kidney injury (AKI) in the postoperative period of cardiac surgery. Methods: A prospective cohort study including 51 patients exposed to coronary artery bypass surgery, valve replacement, or combined surgery (bypass surgery and valve replacement) without history of kidney disease and kidney transplant, and who were followed from the preoperative period until 72 hours after surgery. Acute renal failure was defined as baseline creatinine increase of 0.3 mg/dL in 48 hours or less, or its increase from 1.5 to 1.9-fold, or a reduction in urine flow <0.5mL/kg/h for 6 hours. The Kidney Disease: Improving Global Outcomes (KDIGO) classification was used. Results: The KDIGO classification showed that 92.2% of patients had renal impairment. The urinary flow criterion of this classification alone showed that 31.4% of patients had renal dysfunction in stage of risk, 33.3% in stage of renal injury, and 21.6% in stage of renal failure. By the serum creatinine criterion, 27.5% were identified in the stage of risk, 3.9% in stage of injury and another 3.9% in stage of kidney failure. Conclusion: A high percentage of patients in the postoperative period of cardiac surgery (coronary artery bypass surgery and valve replacement) progressed to acute kidney injury. ResumoObjetivo: Identificar a ocorrência de lesão renal aguda em pós-operatório de cirurgia cardíaca. Métodos: Estudo de coorte prospectivo que incluiu 51 pacientes expostos a cirurgia de revascularização do miocárdio, troca valvar ou cirurgia combinada (revascularização do miocárdio e troca valvar), sem antecedentes de doença renal e de transplante renal e que foram acompanhados desde o pré-operatório até 72 horas de pós-operatório. Foi definido como lesão renal aguda o aumento de 0,3mg/dL em tempo menor ou igual a 48 horas ou aumento de 1,5 a 1,9 vez da creatinina basal, ou ainda redução do fluxo urinário <0,5mL/kg/h por 6 horas. Foi utilizada a classificação Kidney Disease: Improving Global Outcomes (KDIGO). Resultados: A classificação KDIGO sinalizou 92,2% dos pacientes com disfunção renal. O critério fluxo urinário dessa classificação isoladamente mostrou que 31,4% dos pacientes apresentaram disfunção renal no estágio de risco, 33,3% no estágio de lesão renal, e 21,6% no estágio de falência renal. Pelo critério creatinina sérica, foram identificados 27,5% no estágio de risco e, nos estágios de lesão e falência renal, foram identificados 3,9% pacientes em cada. Conclusão: Um percentual elevado de pacientes em pós-operatório de cirurgia cardíaca (revascularização miocárdica e troca valvar) progrediu com lesão renal aguda.

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Prognostic Value of Acute Kidney Injury after Cardiac Surgery according to Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO) Criteria

Cited by 138 publications

References 36 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

Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study

Lesão renal aguda no pós-operatório de cirurgia cardíaca

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