Relationship between a perioperative intravenous fluid administration strategy and acute kidney injury following off-pump coronary artery bypass surgery: an observational study

Abstract

IntroductionSaline-based and hydroxyethyl starch solutions are associated with increased risk of renal dysfunction. In the present study, we tested the hypothesis that balanced solutions and a limited volume of hydroxyethyl starch solution (renal protective fluid management [RPF] strategy) would decrease the incidence of postoperative acute kidney injury (AKI) and improve clinical outcomes in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).MethodsWe investigated 783 patients who underwent elective OPCAB. All patients who underwent OPCAB between 1 January 2010 and 4 July 2012 formed the control group and were given intravenous fluids with saline-based solutions and unlimited volumes of colloid solutions. All patients who underwent OPCAB between 5 July 2012 and 31 December 2013 formed the RPF group and were given intravenous fluids with RPF. The primary outcome was the incidence of postoperative AKI. Secondary outcomes included the incidence of severe AKI, requirement for renal replacement therapy, renal outcome at the time of discharge, and other clinical outcomes.ResultsPostoperative AKI occurred in 33 patients (14.4 %) in the RPF group compared with 210 patients (37.9 %) in the control group (P < 0.001). The incidences of severe AKI and persistent AKI after OPCAB were significantly lower, and the postoperative extubation time and duration of hospital stay were significantly shorter, in patients in the RPF group than in those in the control group. After adjustment by multivariate regression analyses and inverse probability of treatment weighting adjustment, the RPF group was independently associated with a lower incidence of postoperative AKI, severe AKI, and persistent AKI and a shorter postoperative extubation time and duration of hospital stay.ConclusionsThe RPF strategy is associated with a significantly decreased incidence of postoperative, severe, and persistent AKI in patients undergoing OPCAB, although residual confounding may be present.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1065-8) contains supplementary material, which is available to authorized users.

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…Moderate glucose control (127–179 mg/dL) was found in a randomized controlled trial (RCT) to be preferable to tight control (≤126 mg/dL) in patients undergoing coronary artery bypass grafting, resulting in lower rates of AKI and mortality, with the most important factor being avoidance of glucose variability throughout the entire perioperative time frame . The use of balanced crystalloid solutions guided by measures of fluid responsiveness is supported by the current literature and is consistent with the recommendations for fluid management in critically ill patients with sepsis . The administration of hydroxyethyl starch is not indicated for patients at risk of CS‐AKI because of its demonstrated renal toxicity .…”

“…118,119 The use of balanced crystalloid solutions guided by measures of fluid responsiveness is supported by the current literature and is consistent with the recommendations for fluid management in critically ill patients with sepsis. 97,[120][121][122][123] The administration of hydroxyethyl starch is not indicated for patients at risk of CS-AKI because of its demonstrated renal toxicity. 97,121 Although albumin may have a role preoperatively in patients with hypoalbuminemia, 124 we suggest limiting colloid administration in cardiac surgery patients as much as possible and recommend balanced crystalloid solutions as replacement fluid, in keeping with the literature.…”

Predictive value of acute kidney injury for major adverse cardiovascular events following tricuspid annuloplasty: A comparison of three consensus criteria

“…In order to prevent the development of AKI in patients undergoing TA, strategies such as improving diabetic and hypertensive control, avoidance of nephrotoxic medication should be implemented. Further studies using methods such as statin therapy [37], saline-based crystalloid solution [38], and remote ischemic preconditioning [39] could further elucidate the protective role of AKI by these strategies.…”

Einfluss der Kardioanästhesie auf das Patientenoutcome

“…Die chloridrestriktive Volumenzufuhr scheint einen protektiven Einfluss auf das perioperative AKI zu haben. In mehreren Studien konnte gezeigt werden, dass die Zufuhr isotoner kristalloider Lösungen mit einer geringeren Rate an akutem Nierenversagen einherging als die Zufuhr von chloridhaltigen kristalloiden Lösungen [79,80].…”