Risk Factors and Outcome of Acute Kidney Injury after Isolated CABG Surgery: a Prospective Cohort Study

Abstract

Background Acute kidney injury (AKI) is a frequent event after cardiac surgery with increased mortality and morbidity. We explored frequency, risk factors, and associated morbidity and mortality of AKI after isolated coronary artery bypass grafting (CABG) surgery at a single institution. Methods All consecutive adults undergoing CABG surgery from March 2013 to October 2016 were assessed for development and severity of AKI based on Acute Kidney Injury Network (AKIN) criteria. The patients were also investigated regarding their need for renal replacement therapy (RRT), predictive risk factors, and associated outcomes, including duration of mechanical ventilation, mortality, intensive care unit (ICU) and hospital length of stay. Results Of 1737 patients in the study, 275 (15.8%) developed AKI. Twenty-five (12.8%) cases required RRT. Patients with AKI had longer ventilation time, ICU and hospital length of stay ( P <0.001). Mortality rates were 28 (10.2%) and 22 (1.5%) in patients with and without AKI, respectively ( P <0.001). There was a strong association between advanced age (aOR=1.016, 95% CI=1.002-1.030, P =0.028), diabetes (aOR=1.36, 95% CI=1.022-1.809, P =0.035), on-pump surgery (aOR=2.63, 95% CI=1.543-4.483, P <0.001), transfusion of more than 1 unit of red blood cells (aOR=2.154, 95% CI=1.237-3.753, P =0.007), and prolonged mechanical ventilation and development of AKI (aOR=2.697, 95% CI=1.02407.071, P <0.001). AKI was seen less frequently in those with opium abuse (aOR=0.613, 95% CI=0.409-0.921, P =0.018). Conclusion We demonstrated that advanced age, diabetes, on-pump surgery, red blood cell transfusion, and prolonged mechanical ventilation were independent positive risk factors for the development of AKI after isolated CABG while opium abuse was a protective factor.

The effect of opium addiction on short-term postoperative outcomes after coronary artery bypass graft surgery: A prospective observational cohort study

“…Despite the potential negative impact of opium addiction in patients undergoing CABG surgery, some studies suggest protective effects of opium abuse as a protective factors in these patients. In a study by Amini et al has shown that patients with opium abuse after CABG had significantly less frequent of acute kidney injury compared to non-opium abusers [ 40 ]. Also, Maghsoudi et al reported that the length of inotropic agents in CABG perioperative period was significantly lower in opium addicted compared to non-opium dependent patients [ 33 ].…”

Cardiopulmonary bypass management and acute kidney injury in 118 Jehovah’s Witness patients: a retrospective propensity-matched multicentre cohort from 30,942 patients

“…20 Transfusion in low-risk patients has been associated with an 8-to 10-fold increase in adverse outcomes 21 and has been associated with AKI in cardiac surgical patients. 22,23 We found reduced AKI in patients refusing transfusion and no difference in morbidity or mortality. Furthermore, a recent publication found no additional cost associated with refusal of transfusion in cardiac surgery.…”

Early and long-term outcomes of coronary artery bypass surgery with and without use of heart-lung machine and with special respect to renal function - A retrospective study

“…neutrophils, and different biochemical pathways may result in microthrombosis, microemboli and depletion of coagulation factors [22]. These factors contribute to tissue injury and endothelial dysfunction, to predisposing patients to organ injury and to increasing perivascular edema [22, 27]. Renal dysfunction can be a common complication after coronary artery bypass surgery with use of heart-lung machine [4, 9].…”