Potentially Modifiable Predictors for Renal Replacement Therapy in Patients with Cardiac Surgery Associated-Acute Kidney Injury: a Propensity Score-Matched Case-Control Study

Abstract

Objective To discover potentially modifiable perioperative predictors for renal replacement therapy (RRT) in patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods A cohort of 1773 consecutive cardiac surgery patients with postoperative acute kidney injury (AKI) from January 2013 to December 2015 were included retrospectively. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcome was CSA-AKI requiring renal replacement therapy (AKI-RRT). The initiation of RRT was based on clinical judgment regarding severe volume overload, metabolic abnormality ( e.g ., acidosis, hyperkalemia), and oliguria. Patients with AKI-RRT were matched 1:1 with patients without AKI-RRT by a propensity score, to exclude the influence of patients' demographics, comorbidities, and baseline renal function. Multivariable regression was performed to identify the predictors in the matched sample. Results AKI-RRT occurred in 4.4% of the entire cohort (n=78/1773), with 28.2% of in-hospital mortality (n=22/78). With the propensity score, 78 pairs of patients were matched 1:1 and the variables found to be predictors of AKI-RRT included the contrast exposure within 3 days before surgery (odds ratio [OR]=2.932), central venous pressure (CVP) >10 mmHg on intensive care unit (ICU) admission (OR=1.646 per mmHg increase), and erythrocyte transfusions on the 1 st day of surgery (OR=1.742 per unit increase). Conclusion AKI-RRT is associated with high mortality. The potentially modifiable predictors found in this study require concern and interventions to prevent CSA-AKI patients from worsening prognosis.

Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) in Adults and Pediatrics; Prevention is the Optimal Management

“…In our study, this was 13.1%, slightly lower than the reported literature between 15%-30% [Karim 2017]. CSA-AKI is the most expensive complication, especially when using RRT Jiang 2019]. Our study, like others, showed that stage 1 was the most common type (68.2%).…”

“…Our study, like others, showed that stage 1 was the most common type (68.2%). Jiang and colleagues reported high mortality of CSA-AKI-RRT and recommended adjustment of the modifiable predictors to help in prevention [Jiang 2019].…”

Ultrastructural examination of left internal mammary artery under electron microscopy in patients with chronic kidney disease who underwent coronary bypass surgery

“…Cardiac surgery which has shown a rapid development with invention of the cardiopulmonary bypass machine in the second half of the 20th century, is still continuing to develop and has been successfully performed in many centers. The aim of CABG operation is to provide sufficient blood flow to ischemic heart site, to improve quality of life of the patient, and to prolong lifetime [14][15][16]. Patency rate of the autogenous grafts used for this operation determines patients' quality of life and the success of CABG operations.…”