The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery

Swaminathan, Madhav; Phillips-Bute, Barbara; Conlon, Peter J.; Smith, Peter K.; Newman, Mark F.; Stafford‐Smith, Mark

doi:10.1016/s0003-4975(03)00558-7

Cited by 234 publications

(177 citation statements)

References 32 publications

Supporting

Mentioning

163

Contrasting

Unclassified

Order By: Relevance

“…Hemodilution during CBP has been identified recently as a risk factor for AKI. [27][28][29] In a comprehensive and elegant study, Habib and colleagues [23] established a detrimental threshold of hemodilution when the nadir hematocrit was <24%. They also demonstrated that prolonged CBP, intraoperative transfusion of red cells, and preoperative impaired renal function exacerbated the probability of AKI.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Profile for Acute Kidney Injury after Cardiac Surgery Is Different According to the Level of Baseline Renal Function

Lombardi¹,

Ferreiro

2008

Renal Failure

View full text Add to dashboard Cite

Acute kidney injury (AKI) occurs frequently after cardiac surgery. Although numerous variables were identified as predictors for AKI, there is a lack of information about possible differences in risk factors according to the level of preoperative renal function. Preoperative, intraoperative, and postoperative data from 4118 adult patients submitted to cardiac surgery from January 1, 2000, to December 31, 2005, were included in the study. AKI was defined by an increase in serum creatinine (S Cr ) ≥ 0.3 mg/dL after surgery. Patients were stratified into two groups: group 1, C Cr ≥ 60 mL/min/1.73 m 2 BSA; group 2, C Cr < 60 mL/min/1.73 m 2 BSA. Risk factors were assessed using a multiple logistic regression model. In all, 749 patients (42.5%) developed AKI. The mortality rate of the entire population was a 5.2%. In patients of group 1 (n = 2678), the variables independently associated with the onset of AKI were age, diabetes, preoperative use of diuretics, non-scheduled surgery, cardiopulmonary by-pass (CPB) time, CPB mean arterial pressure, hemodilution, and postoperative use of norepinephrine. Baseline S Cr was associated with AKI only in patients of group 2 (n = 1440). Age, EuroSCORE, non-coronary surgery, hemodilution, and postoperative use of vasoactive drugs were also predictors of AKI in this group of patients. The mortality rate was significantly higher in group 2 than group 1 (8.5% vs. 3.6%, p = 0.000). In conclusion, the present study demonstrated a difference in variables associated with postoperative AKI, according to baseline renal function. The degree of preoperative renal function was a predictor of AKI only in patients with CKD stages 3-4, as well as other risk factors. In addition to other well known risk factors for AKI in this setting, the use of diuretics in patients of group 1 and the level of hemodilution during CPB in both groups should be emphasized, as they are potentially modifiable.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk Factors Profile for Acute Kidney Injury after Cardiac Surgery Is Different According to the Level of Baseline Renal Function

Lombardi¹,

Ferreiro

2008

Renal Failure

View full text Add to dashboard Cite

show abstract

“…3,10,11,21 During acute hemodilution, experimental models demonstrate that the kidney becomes hypoxic at much higher Hb concentrations than the brain or heart. 14,22,23 This may partially explain the increased incidence of renal failure in these anemic patients.…”

Section: Hemodilution Increases the Risk Of Renal Injurymentioning

confidence: 99%

Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

Tsui

Dattani

Marsden

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

“…This definition differs slightly from the Acute Kidney Injury Network criteria that require the sCr rise to occur within 48 hours (3). Because of the possibility of hemodilution associated with CPB, we anticipated an early postoperative decline in sCr concentration in some patients and a delay in achieving the Acute Kidney Injury Network threshold for a diagnosis of AKI (1,10). We therefore adopted a 3-day window for the rise in sCr.…”

Section: Definition Of Acute Kidney Injurymentioning

confidence: 99%

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Wald

Liangos

Perianayagam

et al. 2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives:Little is known about the performance of plasma cystatin C (CysC) in patients undergoing cardiopulmonary bypass (CPB) and its utility in the early diagnosis of acute kidney injury (AKI). In this post hoc analysis, the goal was to determine whether plasma cystatin C, measured 2 hours after the conclusion of CPB, is a reliable marker of AKI.Design, setting, participants, & measurements: Plasma CysC was measured in 150 patients undergoing CPB at the following times: preoperatively, 2 hours after the conclusion of CPB, postoperative day 1, and postoperative day 2. Plasma CysC levels were related to the development of AKI as defined by an increase in serum creatinine of >50% or >0.3 mg/dl from baseline up to 3 days postoperative. Mixed linear models were used to evaluate the relationship of serial plasma CysC values with AKI. The discriminatory capacity of plasma CysC was estimated using receiver operating characteristic curves. Logistic regression was utilized to assess the adjusted relationship between plasma CysC and subsequent AKI.Results: AKI developed in 47 (31.3%) patients. Plasma CysC was higher at all times among patients who developed AKI compared with those who did not (P < 0.0001). The discriminatory capacity of plasma CysC measured preoperatively and 2 hours after the conclusion of CPB was modest.Conclusions: Serial measures of plasma CysC are highly correlated with the development of AKI. However, the discriminatory capacity of plasma CysC as an early marker of AKI remains limited.

show abstract

The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery

Cited by 234 publications

References 32 publications

Risk Factors Profile for Acute Kidney Injury after Cardiac Surgery Is Different According to the Level of Baseline Renal Function

Risk Factors Profile for Acute Kidney Injury after Cardiac Surgery Is Different According to the Level of Baseline Renal Function

Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Contact Info

Product

Resources

About