Lesão renal aguda após revascularização do miocárdio com circulação extracorpórea

Machado, Maurício de Nassau; Miranda, Rafael Carlos; Takakura, Isabela Thomaz; Palmegiani, Eduardo; Santos, Carlos Alberto dos; Oliveira, Marcos Aurélio Barboza de; Mouco, Osana M.; Hernandes, Mauro Esteves; Lemos, Maria Angélica; Maia, Lília Nigro

doi:10.1590/s0066-782x2009000900008

Cited by 21 publications

(9 citation statements)

References 25 publications

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“…To the best of our knowledge, this was the first study to compare these three criteria in this kind of population. Patients with AKI diagnosis, regardless of the criterion used, had higher mortality and a higher risk of combined events (death, need for dialysis and/or extended hospitalization); our results are in agreement and support previous evidences regarding the poor prognosis associated with the development of AKI 4,13-16 . It is interesting to highlight, however, that two patients with AKI diagnosed by AKIN criterion, but without renal injury by RIFLE and KDIGO criteria, required dialytic therapy.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Diagnostic Criteria for Acute Kidney Injury in Cardiac Surgery

Sampaio¹,

Máximo²,

Montenegro³

et al. 2013

Arquivos Brasileiros De Cardiologia

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BackgroundThere is considerable controversy regarding the diagnosis of Acute Kidney Injury (AKI), and there are over 30 different definitions. ObjectiveTo evaluate the incidence and risk factors for the development of AKI following cardiac surgery according to the RIFLE, AKIN and KDIGO criteria, and compare the prognostic power of these criteria. MethodsCross-sectional study that included 321 consecutive patients (median age 62 [53-71] years; 140 men) undergoing cardiac surgery between June 2011 and January 2012. The patients were followed for up to 30 days, for a composite outcome (mortality, need for dialysis and extended hospitalization). ResultsThe incidence of AKI ranged from 15% - 51%, accordingly to the diagnostic criterion adopted. While age was associated with risk of AKI in the three criteria, there were variations in the remaining risk factors. During follow-up, 89 patients developed the outcome and all criteria were associated with increased risk in the univariate Cox analysis and after adjustment for age, gender, diabetes, and type of surgery. However, after further adjustment for extracorporeal circulation and the presence of low cardiac output, only AKI diagnosed by the KDIGO criterion maintained this significant association (HR= 1.89 [95% CI: 1.18 - 3.06]). ConclusionThe incidence and risk factors for AKI after cardiac surgery vary significantly according to the diagnostic criteria used. In our analysis, the KDIGO criterion was superior to AKIN and RIFLE with regard its prognostic power.

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Section: Discussionsupporting

confidence: 92%

Comparison of Diagnostic Criteria for Acute Kidney Injury in Cardiac Surgery

Sampaio¹,

Máximo²,

Montenegro³

et al. 2013

Arquivos Brasileiros De Cardiologia

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“…We excluded 268 studies: animal studies (15), reviews (42), no epidemiological data available (177), not about CRS-1 (23), no data about AKI or WRF (8) and studies evaluating a specific intervention (3). Finally, we included 64 papers (n = 509,766 patients), containing data on AKI in AHF patients (18 studies; 29,202 patients) [4,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26], ACS (15 studies; 282,113 patients) [13,27,28,29,30,31,32,33,34,35,36,37,38,39,40] and CS (32 studies; 198,451 patients) [41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72] (table 1). One study contained information about AHF as well as ACS and is therefore used in both groups [13].…”

Section: Resultsmentioning

confidence: 99%

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Vandenberghe¹,

Gevaert

Kellum

et al. 2015

Cardiorenal Med

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Background: We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). Summary: We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOS_ICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOS_hosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOS_ICU = 10.6 days and that of LOS_hosp = 20.2 days). Key Messages: Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.

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“…In cardiovascular surgery, several studies have been indicating that ARL is a frequent complication, being associated to high rates of mortality and prolonged stay in ICU [12][13][14]. Machado et al [12] refer mortalities within 30 days of patients with and without acute renal lesion of 12.6% and 1.4%, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Machado et al [12] refer mortalities within 30 days of patients with and without acute renal lesion of 12.6% and 1.4%, respectively. Thakar et al [15] attribute to ARL high risk alone for mortality compared to other types of complications in the postoperative and developed an ARL prediction score in the postoperative of cardiac surgery, incorporating all major risk factors [16].…”

Section: Resultsmentioning

confidence: 99%

Uso de nifedipina e incidência de lesão renal aguda em pós-operatório de cirurgia de revascularização do miocárdio com CEC

Passaroni¹,

Silva²,

Martins³

et al. 2010

Rev Bras Cir Cardiovasc

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Uso de nifedipina e incidência de lesão renal aguda em pós-operatório de cirurgia de revascularização do miocárdio com CECUse of nifedipine and acute kidney injury incidences in postoperative of myocardial revascularization surgery with cardiopulmonary bypass Abstract Objective: The objective of this work was to evaluate the influence of the use of nifedipine on the outcome of renal function in patients undergoing myocardial revascularization with cardiopulmonary bypass.Methods: The casuistics and variables related to cardiopulmonary bypass were studied. Serum creatinine levels were measured preoperatively, 24, 48 hours and on 7th day postoperatively. Renal failure was defined as an increase in 30% of serum creatinine levels at 24 or 48 hours postoperatively compared to those at baseline. Patients were assigned to four groups: G1 (patients who received nifedipine preoperatively); G2 (patients who received nifedipine postoperatively); G3 (patients who received nifedipine pre and postoperatively) and G4 (patients who did not receive nifedipine).Results: The mean serum creatinine levels postoperatively presented greater rise in G4 (G4>G1=G2=G3), and G4 also presented a higher percentage of patients with acute renal failure (G4>G1 and G4>G3, P<0.05; G1=G3 and G2=G4, P>0.05).Conclusion: The evaluation of serum creatinine values and incidence of acute kidney injury postoperatively suggest a possible nefro-potective effect of nifedipine in patients undergoing myocardial revascularization with cardiopulmonary bypass.Descriptors: Cardiopulmonary bypass. Acute renal Insufficiency. Myocardial revascularization. Resumo Objetivo: Avaliar durante o período perioperatório o uso da nifedipina na incidência de lesão renal aguda dos pacientes submetidos à revascularização do miocárdio com circulação extracorpórea.Métodos: Foram estudados, de modo prospectivo e sequencial, 94 pacientes submetidos à revascularização do miocárdio com circulação extracorpórea. As dosagens da creatinina sérica foram realizadas durante pré-operatório e pós-operatório de 24, 48 horas e no 7º dia. Estabeleceu-se como definição para presença de lesão renal a elevação da creatinina sérica 30% em relação ao seu valor basal nas primeiras 24 ou 48 horas de pós-operatório. Os pacientes foram divididos em quatro grupos: G1, que recebeu nifedipina no pré-operatório; G2, que recebeu nifedipina no pós-operatório; G3, que recebeu nifedipina no pré e pós-operatórios e, G4, que não recebeu nifedipina.Resultados: O grupo G4 mostrou maior elevação do percentual de creatinina sérica e maior percentual de pacientes que apresentaram insuficiência renal aguda em relação aos demais grupos no pós-operatório.Conclusão: Os valores da creatinina sérica e a incidência de lesão renal aguda no pós-operatório sugerem possível efeito nefroprotetor da nifedipina em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea.Descritores: Circulação extracorpórea. Insuficiência renal aguda. Revascularização miocárdica.

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Lesão renal aguda após revascularização do miocárdio com circulação extracorpórea

Cited by 21 publications

References 25 publications

Comparison of Diagnostic Criteria for Acute Kidney Injury in Cardiac Surgery

Comparison of Diagnostic Criteria for Acute Kidney Injury in Cardiac Surgery

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Uso de nifedipina e incidência de lesão renal aguda em pós-operatório de cirurgia de revascularização do miocárdio com CEC

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