Acute Kidney Injury after Cardiac Surgery in Patients Without Chronic Kidney Disease

Abstract

IntroductionAmong patients undergoing cardiac surgery, the occurrence of acute renal injury appears to be associated with worse prognosis and increased mortality. The objective of this study was to evaluate risk factors and the impact this complication on mortality and survival after cardiac surgery among patients without chronic kidney disease.MethodsIn this retrospective study, we reviewed the medical records of 142 patients who underwent elective coronary artery bypass grafting, valve replacement (single or multiple), or both (simultaneously) at a tertiary care hospital.ResultsAmong the 142 patients evaluated, the mean age was 58.28±13.87 years and 80 (56.33%) were female. The postoperative incidence of acute renal injury was 43.66%. Univariate analysis between the groups with and without acute renal injury revealed no significant differences, whereas multivariate analysis showed that risk factors for acute renal injury included valve replacement (OR=4.7, P=0.002, 95% CI=1.76-12.62, age (OR=1.044, P=0.012, 95% CI=1.01-1.07), previous cardiac surgery (OR=36.1, P=0.015, 95% CI=1.99-653.85), postoperative use of the vasoactive drug norepinephrine (OR=3.32, P=0.013, 95% CI=1.29-8.58) and dobutamine (OR=5.3, P=0.019, 95% CI=1.32-21.64). In our sample, there were 30 deaths, of which 25 had acute kidney injury. Survival was also lower among the patients with this complication, especially those who had required hemodialysis (OR=2.60, P<0.001, 95% CI=1.01-6.70) or had previously undergone cardiac surgery (OR=3.68, P<0.001, 95% CI=1.09-12.37).ConclusionOur findings underscore the importance of identifying risk factors for developing acute renal injury after cardiac surgery, which can further the development of effective renoprotective strategies.

Blood Pressure and Blood Pressure Deficits as Predictors of Acute Kidney Injury in Vasopressor Dependent Patients Post Cardiovascular Surgery

“…In the present study, 31% of the included patients developed AKI. Other studies showed an incidence of AKI to range from 43.6% [20] to 47% [21] in post cardiac surgery patients. These differences between other studies and ours may be related to differences in study design, patients' profile, and diagnostic criteria.…”

Prevalence of acute kidney injury after cardiac surgery:A systematic review and meta-analysis on risk factors and different diagnostic criterias(AKIN,RIFLE,KDIGO)

“…Based on the random-effects model, the highest prevalence of acute renal failure in patients undergoing cardiac surgery in Brazil was 45.7% (47.6% 43.6-47.8%, CI = 95%) [22,24,27] [25,32,35,40]. Finally, the prevalence of acute renal failure in Italy was 10.6% (9.8-11.3%, CI = 95%) [28,31,39] (Fig.…”

“…A total of 21 studies from 6 countries that met the inclusion criteria were reviewed. Among these studies, 7 studies were from United States (25,34,(36)(37)(38)41,42), 4 studies from Canada (25,32,35,40), 3 studies from Brazil (22,24,27) 3 studies from Italy (28,31,39), one study from England (30), one from Uruguay (23), and one was study from New England (29). Convenient sampling was used to select the participants (n = 21).…”

“…The data were collected mainly from the patients' medical records and especially from the intensive care units (n = 20). Of the 21 selected studies, 8 studies met the Acute Kidney Injury Network (AKIN) criteria (22,(25)(26)(27)34,37,39,41), 6 studies were in line with RIFLE criteria (31,32,33,36,40,42). And 2 studies met the Kidney Disease Improving Global Outcomes (KDIGO) criteria to diagnose acute renal failure (23,24).…”

“…found the age of over 63 is a single risk factor for AKI. Besides, loss of the renal functional reserve due to the gradual decrease in the glomerular filtration rate deteriorated at older ages exposes old patients at the higher risk of renal damage when undergoing hypoperfusion (64,65)…”