Urine Output during Cardiopulmonary Bypass Predicts Acute Kidney Injury after Coronary Artery Bypass Grafting

Yılmaz, Mehmet; Aksoy, Rezan; Yılmaz, Vildan Kılıç; Balcı, Canan; Düzyol, Çağrı; Kunt, Atike Tekeli

doi:10.1532/hsf.1495

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…Acute kidney injury is one of the major complications that affect mortality and morbidity after open heart surgery. There are several contributing factors to the development of AKI after open heart surgery [24,25]. However, the most crucial point to be considered for protecting patients from developing AKI is to ensure continuous adequate renal perfusion at every stage of the operation.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Effects of Inhalational Anesthesia with Sevoflurane and Total Intravenous Anesthesia in Open Heart Surgery

Yilmaz,

Kilic Yilmaz,

Ozer Yurt

et al. 2024

HSF

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Background: The primary objective of this study was to compare sevoflurane inhalation anesthesia with total intravenous anesthesia (TIVA) in terms of its effectiveness in maintaining adequate depth of anesthesia during all open heart surgery procedures, including cardiopulmonary bypass. The study's secondary objective was to compare sevoflurane inhalation anesthesia with TIVA regarding the impact on the time of tracheal extubation and the incidence of postoperative acute kidney injury during open heart surgeries. Methods: A total of 58 patients undergoing open heart surgery were included, with 30 receiving sevoflurane inhalation anesthesia and 28 receiving TIVA. Demographic characteristics, intraoperative parameters, and postoperative outcomes were recorded and analyzed. Statistical analysis revealed no significant differences in Bispectral Index (BIS) monitor values, mean arterial pressure, body temperature, or other intraoperative parameters between the two groups. Notably, the time to tracheal extubation was significantly shorter in the Sevoflurane group compared to the TIVA group, although both groups exhibited similar rates of postoperative acute kidney injury (AKI). Results: None of the patients had complaints of intraoperative awareness. The mean arterial pressure, body temperature, and bispectral index values during and before cardiopulmonary bypass were similar between the groups. Postoperative variables such as intensive care unit stay duration, incidence of acute kidney injury, and immediate and 24-hour post-extubation visual analog scale values were similar between the groups. The tracheal extubation time was found to be statistically shorter in the sevoflurane group. Conclusion: We believe that sevoflurane inhalation anesthesia can achieve adequate depth of anesthesia during the intraoperative period in open heart surgery without increasing the rate of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

“…Maintaining continuous renal perfusion is achieved with stable hemodynamics. The incidence rate of acute renal injury after acute heart surgery ranges from 1% to 30% [24]. There are two separate studies conducted on AKI following open heart surgery in the period before the initiation of sevoflurane use during CPB in our clinic.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Inhalational Anesthesia with Sevoflurane and Total Intravenous Anesthesia in Open Heart Surgery

Yilmaz,

Kilic Yilmaz,

Ozer Yurt

et al. 2024

HSF

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“…Since now, no studies have reported the same finding. Similar studies ( 38 , 39 ) have only evaluated the urinary output volume during CABG. The findings of these studies showed the prognostic role of the urinary output during surgery in the AKI incidence after surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Patient’s Kidney Function Based on Kidney Disease Improving Global Outcomes (KDIGO) Criteria and Clinical Parameters in Isolated Coronary Artery Bypass Graft (CABG) Surgery in On-Pump and Off-pump Methods in Patients with Low Cardiac Output Syndrome (LCOS) After Surgery

et al. 2020

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Background Acute kidney injury (AKI) is one of the serious complications of cardiac surgery. It is worsened when accompanied by low cardiac output syndrome. Objectives In this study, we compared kidney function based on the KDIGO criteria in isolated on-pump and off-pump coronary artery bypass graft (CABG) surgery. Methods In this cohort study, 52 patients with LCOS were enrolled after on-pump (28 patients) and off-pump (24 patients) CABG. In the first six hours after ICU entrance, blood samples were taken for serum creatinine based on routine. For determining AKI after surgery, we used the KDIGO criteria as a primary endpoint. Also, some clinical parameters were recorded before, during, and after surgery. The data were analyzed by SPSS software, version 24, using paired and independent t -test, ANOVA, and Pearson correlation test and non-parametric tests such as Mann-Whitney and Kruskal-Wallis tests at a significance level of P < 0.05. Results There was no significant difference in age (P = 0.3) and gender (P = 0.57) between the two groups. Among cardiac disease risk factors, only hypertension (P = 0.02) had a significant difference between the two groups, but AKI in patients with hypertension did not show a significant difference (P = 0.09). In paraclinical parameters, serum creatinine showed a significant difference before and after surgery in on-pump (P < 0.001) and off-pump (P = 0.007) groups. Also, this parameter had a significant difference at 6 h, 12 h, 24 h, and 48 h after surgery between the on-pump and on-pump groups. The AKI incidence showed a significant difference between the two groups (P < 0.001). Conclusions The incidence of AKI was more in on-pump patients than in off-pump patients. Also, a significant difference was observed between their clinical parameters. Thus, to improve the patients’ clinical outcomes and lower the health costs, we suggest that patients with a high risk of LCOS be followed up after CABG, especially on-pump CABG.

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“…In a previous retrospective study, Yilmaz et al reported that urinary output during CPB surgery was an important indicator of postoperative AKI [13] . Likewise, in a retrospective study, Song et al concluded that urinary output during CPB surgery was a simple and feasible marker to indicate postoperative AKI [14] .…”

Section: Discussionmentioning

confidence: 99%

“…According to some studies, there is no relationship between AKI and the amount of urinary output per hour during CABG [10][11][12] . However, two recent retrospective studies reported that the urine volume during CPB could be used to predict postoperative renal injury [13,14] . ACC in cardiac surgery is an important risk factor for postoperative acute renal failure due to nonpulsatile blood flow.…”

Section: Introductionmentioning

confidence: 99%

Urinary Output During The Aortic Cross-Clamping Period In Isolated Coronary Artery Bypass Grafting Surgery: An Indicator of Postoperative Acute Kidney Injury.

Yılmaz¹,

Turan²,

Yılmaz³

et al. 2019

GKDA Derg

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Objective: Postoperative acute kidney injury (AKI) is a common and serious complication of coronary artery bypass grafting surgery (CABG). In this prospective study, we investigated the efficacy of urinary output during aortic cross-clamping (ACC) in cardiac surgery in determining postoperative AKI. Methods: This prospective study was performed on patients who underwent isolated coronary artery bypass surgery between January 2016 and April 2017. Patients with an increase of more than 1.5 times in their preoperative creatinine values on their third postoperative day were considered to have acute kidney injury according to RIFLE criteria. The patients were divided into two groups as AKI (+) and AKI (-), regarding presence of AKI. Results: Acute kidney damage developed in 12 patients out of 146 patients studied. Demographic data, and intraoperative variables were similar between the groups (p>0.05). The urinary output during ACC (mL/kg/h) of the AKI (-) group was significantly higher than that of the AKI (+) group (p=0.045). Conclusion: Our data have demonstrated that urinary output during ACC and cardiopulmonary bypass (CPB) periods may be a valuable criterion for early diagnosis of AKI. We suppose that, the patients with a urine output less than 3.345 ml/kg/h during the ACC period carry a high risk for postoperative AKI.

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Urine Output during Cardiopulmonary Bypass Predicts Acute Kidney Injury after Coronary Artery Bypass Grafting

Cited by 6 publications

References 19 publications

Comparison of the Effects of Inhalational Anesthesia with Sevoflurane and Total Intravenous Anesthesia in Open Heart Surgery

Comparison of the Effects of Inhalational Anesthesia with Sevoflurane and Total Intravenous Anesthesia in Open Heart Surgery

Comparison of Patient’s Kidney Function Based on Kidney Disease Improving Global Outcomes (KDIGO) Criteria and Clinical Parameters in Isolated Coronary Artery Bypass Graft (CABG) Surgery in On-Pump and Off-pump Methods in Patients with Low Cardiac Output Syndrome (LCOS) After Surgery

Urinary Output During The Aortic Cross-Clamping Period In Isolated Coronary Artery Bypass Grafting Surgery: An Indicator of Postoperative Acute Kidney Injury.

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