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

Xie, Xiangcheng; Wan, Xin; Ji, Xiaobing; Chen, Xin; Liu, Jian; Chen, Wen; Cao, Changchun

doi:10.2169/internalmedicine.56.7638

Cited by 34 publications

(25 citation statements)

References 48 publications

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“…Acute kidney injury (AKI), which is mainly defined as a sudden onset of decreased renal function characterized by increased serum creatinine (SCr) levels or oliguria, is a common complication during perioperative stage and associated with prolonged hospitalization and high mortality. The incidence of AKI associated with cardiovascular surgery varies according to the type of operation, usually ∼4.2-36.0% using either the risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE), the Acute Kidney Injury Network (AKIN), or the Kidney Disease Improving Global Outcomes (KDIGO) criteria (1)(2)(3)(4)(5). Cardiac surgery-associated acute kidney injury (CSA-AKI) is a widely recognized complication after cardiac surgery by cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit (6).…”

Section: Introductionmentioning

confidence: 99%

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Zhou

Hao

et al. 2020

Front. Med.

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Background: Acute kidney injury (AKI) is a common complication of cardiac surgery, which could lead to increased morbidity and mortality. Acute type A aortic dissection (AAAD) is a life-threatening cardiac disease and can be closely related to post-operative AKI. However, data on the incidence of AKI defined by the newest Kidney Disease: Improving Global Outcomes (KDIGO) criteria and in-hospital mortality of a homogeneous population who underwent AAAD are limited. We aimed to investigate the incidence of AKI defined by the KDIGO criteria and the risk factors associated with the outcomes among AAAD-induced AKI patients. Methods: We reviewed 335 patients who underwent surgical treatment for AAAD between March 2009 and June 2016. We screened the patients' AKI status and analyzed probably risk factors of AKI and in-hospital mortality. Independent-sample t-test or Chi-square test was performed to identify differences between AKI and non-AKI groups and survivors with AKI and non-survivors with AKI, respectively. The logistic regression model was applied to identify independent risk factors. Results: AKI occurred in 71.94% of AAAD patients, including 85 stage 1 (35.26%), 77 stage 2 (31.95%), and 79 stage 3 (32.78%) patients. The in-hospital mortality rate was 21.16%. Logistic regression analysis showed that the body mass index, chronic kidney disease, chronic liver disease, cardiopulmonary bypass duration, red blood cell transfusion, and hypoproteinemia were the independent significant risk factors of the occurrence of post-operative AKI. The risk factors associated with in-hospital mortality among AAAD-induced AKI patients included AKI stage (odds ratio (OR), 3.322), deep hypothermic circulatory arrest (OR, 2.586), lactic acidosis (OR, 3.407), and continuous renal replacement therapy (OR, 3.156). Li et al. AKI After AAAD Surgery Conclusion: For AAAD patients undergoing surgery, AKI was a common complication, and it increased patients' mortality risk. Therefore, identifying the risk factors of AKI and preventing post-operative AKI are important for improving the post-operative outcomes of AAAD patients.

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Section: Introductionmentioning

confidence: 99%

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Zhou

Hao

et al. 2020

Front. Med.

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show abstract

“…E ach year, more than 2 million patients undergo cardiac operations worldwide [1]. Acute kidney injury (AKI) complicates as many as 36% of these procedures, doubling total hospital costs [2,3]. Even minor changes of serum creatinine in the postoperative period have been associated with decreased survival [4].…”

mentioning

confidence: 99%

Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation

Husain‐Syed

Ferrari

Sharma

et al. 2018

The Annals of Thoracic Surgery

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Among elective cardiac surgical patients with normal resting glomerular filtration rates, preoperative RFR was highly predictive of AKI. A reduced RFR appears to be a novel risk factor for AKI, and measurement of RFR preoperatively can identify patients who are likely to benefit from preventive measures or to select for use of biomarkers for early detection. Larger prospective studies to validate the use of RFR in strategies to prevent AKI are warranted. ClinicalTrials.gov identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759.

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“…Patients undergoing cardiac surgery have a high incidence of AKI [20, 21] because extracorporeal circulation has countless negative effects, especially with a long duration of extracorporeal circulation. In addition, patients who have a poor cardiac output have an increased incidence of AKI incidences because the MAP may be decreased below the lower threshold of the autoregulation curve in these patients [22].…”

Section: Discussionmentioning

confidence: 99%

Association of Intraoperative Hypotension with Acute Kidney Injury after Noncardiac Surgery in Patients Younger than 60 Years Old

Tang

Zhu

Liu

et al. 2019

Kidney Blood Press Res

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Background/Aims: Intraoperative hypotension (IOH) may be associated with surgery-related acute kidney injury (AKI). However, the duration of hypotension that triggers AKI is poorly understood. The incidence of AKI with various durations of IOH and mean arterial pressures (MAPs) was investigated. Materials: A retrospective cohort study of 4,952 patients undergoing noncardiac surgery (2011 to 2016) with MAP monitoring and a length of stay of one or more days was performed. The exclusion criteria were a preoperative estimated glomerular filtration (eGFR) ≤60 mL min^–1 1.73 m^2–1, a preoperative MAP less than 65 mm Hg, dialysis dependence, urologic surgery, age older than 60 years, and a surgical duration of less than 60 min. The primary exposure was IOH, and the primary outcome was AKI (50% or 0.3 mg dL^–1 increase in creatinine) during the first 7 postoperative days. Multivariable logistic regression was used to model the exposure-outcome relationship. Results: AKI occurred in 186 (3.76%) noncardiac surgery patients. The adjusted odds ratio for surgery-related AKI for a MAP of less than 55 mm Hg was 14.11 (95% confidence interval: 5.02–39.69) for an exposure of more than 20 min. Age was not an interaction factor between AKI and IOH. Conclusion: There was a considerably increased risk of postoperative AKI when intraoperative MAP was less than 55 mm Hg for more than 10 min. Strict blood pressure management is recommended even for patients younger than 60 years old.

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

Cited by 34 publications

References 48 publications

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation

Association of Intraoperative Hypotension with Acute Kidney Injury after Noncardiac Surgery in Patients Younger than 60 Years Old

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