Acute Kidney Injury After Cardiac Surgery

Abstract

Background-Acute kidney injury (AKI) after cardiac surgery is a major health issue. Lacking effective therapies, risk factor modification may offer a means of preventing this complication. The objective of the present study was to identify and determine the prognostic importance of such risk factors. Methods and Results-Data from a multicenter cohort of 3500 adult patients who underwent cardiac surgery at 7 hospitals during 2004 were analyzed (using multivariable logistic regression modeling) to determine the independent relationships between 3 thresholds of AKI (Ͼ25%, Ͼ50%, and Ͼ75% decrease in estimated glomerular filtration rate within 1 week of surgery or need for postoperative dialysis) with death rates, as well as to identify modifiable risk factors for AKI. The 3 thresholds of AKI occurred in 24% (nϭ829), 7% (nϭ228), and 3% (nϭ119) of the cohort, respectively. All 3 thresholds were independently associated with a Ͼ4-fold increase in the odds of death and could be predicted with several perioperative variables, including preoperative intra-aortic balloon pump use, urgent surgery, and prolonged cardiopulmonary bypass. In particular, 3 potentially modifiable variables were also independently and strongly associated with AKI. These were preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration. Conclusions-AKI after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication. (Circulation. 2009;119:495-502.)

Fatores de risco para lesão renal aguda após cirurgia cardíaca

“…We have identified several preoperative risk factors for AKI, most of them directly or indirectly related to poor hemodynamic status and/or arterial disease, such as peripheral arterial disease, carotid artery disease and myocardial infarction, similarly to other investigators [7][8][9][10][11][12]. However, in our cohort, CABG surgery alone was not an independent factor associated with postoperative AKI, contrarily to valve surgery, even though coronary artery disease is intimately associated with older age, diabetes mellitus, COPD and peripheral atherosclerosis.…”

“…Other important preoperative variables, such as medications in use and the condition of other organic functions -like the hepatic, hematopoietic and haemostatic functions -should be of concern, mainly in patients who have already presented preoperative renal dysfunction and/or has been enduring congestive heart failure for long time. In addition, the variables associated with postoperative AKI, as well as their value, may be different according to the preoperative baseline renal function [9,22]. However, the cost-effectiveness and practicality of a more accurate preoperative evaluation of the renal and other organic function must be considered before becoming routinely used.…”

Acute kidney injury following total joint arthroplasty: retrospective analysis

“…Blood transfusions have increasingly been implicated with postoperative morbidity and mortality, and blood transfusions in septic patients were associated with increased rates of AKI. 31 Anemic patients undergoing cardiac surgery who received blood transfusions are at increased risk for AKI; [32][33][34] however, whether reduction of the rate of blood transfusion lowers the incidence of AKI following orthopedic surgery requires further study. 35 The rate of perioperative NSAID administration was greater among our controls than the cases.…”

Use of clinically based troponin underestimates the cardiac injury in non-cardiac surgery: a single-centre cohort study in 51,701 consecutive patients

“…[12][13][14][15] The patient characteristics, laboratory values, and postoperative events were retrieved from the hospital electronic charting system, MISYS CPR (QuadraMed Corp, Reston, VA, USA). Surgical information was obtained from ORSOS (McKesson Corp, San Francisco CA, USA), and data regarding drug administration were obtained from the institutional pharmacy database.…”