Acute kidney injury in cardiac surgery

Gaffney, Alan; Sladen, Robert N.

doi:10.1097/aco.0000000000000154

Cited by 75 publications

(68 citation statements)

References 79 publications

(64 reference statements)

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“…The incidence of AKI in the score development population and in validation cohort was 16.9% and 15.7%, respectively, which is congruent with previous reports where the incidence of AKI ranged from 5% to 40% [4,9,16]. Three predictive models for CSA-AKI risk not requiring RRT have been developed so far: NNECDSG [8], MCSPI [7], and AKICS [9].…”

Section: Discussionsupporting

confidence: 68%

“…However, these markers are not widely available in routine practice, and further studies must be developed to extend its use. Neutrophil gelatinase-associated lipocalin is one of the most up-regulated genes and proteins early after AKI and one of the most studied novel biomarkers in the early detection of AKI [16]. Several authors [27,28] have studied the role of NGAL in predicting CSA-AKI and have demonstrated better and earlier predictive power as compared to creatinine.…”

Section: Discussionmentioning

confidence: 99%

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Predicting cardiac surgery–associated acute kidney injury: The CRATE score

Jorge-Monjas

Bustamante‐Munguira

Lorenzo

et al. 2016

Journal of Critical Care

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a b s t r a c t a r t i c l e i n f oKeywords: Cardiac surgery Renal insufficiency Risk prediction Risk score Purpose: Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with increased mortality. The aim was to design a nondialytic AKI score in patients with previously normal renal function undergoing cardiac surgery. Methods: Data were collected on 909 patients who underwent cardiac surgery with cardiopulmonary bypass between 2012 and 2014. A total of 810 patients fulfilled the inclusion criteria. Patients were classified as having AKI based on the RIFLE criteria. Postoperative AKI occurred in 137 patients (16.9%). Several parameters were recorded preoperatively, intraoperatively, and at intensive care unit admission, looking for a univariate and multivariate association with AKI risk. A second data set of 741 patients, from 2 different hospitals, was recorded as a validation cohort. Results: Four independent risk factors were included in the CRATE score: creatinine (odds ratio [OR], 9.66; 95% confidence interval [CI], 4.77-19.56; P b .001), EuroSCORE (OR, 1.40; CI, 1.29-1.52; P b .001), lactate (OR, 1.03; CI, 1.01-1.04; P b .001), and cardiopulmonary bypass time (OR, 1.01; CI, 1.01-1.02; P b .001). The accuracy of the model was good, with an area under the curve of 0.89 (CI, 0.85-0.92). The CRATE score retained good discrimination in validation cohort, with an area under the curve of 0.81 (95% CI, 0.78-0.85). Conclusions: CRATE score is an accurate and easy to calculate risk score that uses affordable and widely available variables in the routine care surgical patients.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Predicting cardiac surgery–associated acute kidney injury: The CRATE score

Jorge-Monjas

Bustamante‐Munguira

Lorenzo

et al. 2016

Journal of Critical Care

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“…Progress has been made during the last years on the definition of the syndrome [i.e., Kidney Disease Improving Global Outcome (KDIGO) criteria, (5)], on better understanding of its pathophysiology, and on the identification of earlier severity stages (6). It is now clear that cardiac surgery associated AKI (CSA-AKI) has a multifactorial origin since different pathways simultaneously affect renal function: patients' pre-operative susceptibility, exogenous and endogenous toxins, metabolic factors, hemodynamic instability, ischemia/reperfusion injury, microembolization, neurohormonal activation, endothelial cells and renal epithelial cells activation, and release of inflammatory mediators and oxidative stress (7)(8)(9). Inflammation, deriving from several pathways, plays a key role in CSA-AKI: cardiopulmonary bypass and its contact activated response, aortic cross-clamp and circulatory arrest, tissue hypoxia, and transfusions co-act leading to a systemic inflammatory response syndrome (7,(10)(11)(12).…”

mentioning

confidence: 99%

“…It is now clear that cardiac surgery associated AKI (CSA-AKI) has a multifactorial origin since different pathways simultaneously affect renal function: patients' pre-operative susceptibility, exogenous and endogenous toxins, metabolic factors, hemodynamic instability, ischemia/reperfusion injury, microembolization, neurohormonal activation, endothelial cells and renal epithelial cells activation, and release of inflammatory mediators and oxidative stress (7)(8)(9). Inflammation, deriving from several pathways, plays a key role in CSA-AKI: cardiopulmonary bypass and its contact activated response, aortic cross-clamp and circulatory arrest, tissue hypoxia, and transfusions co-act leading to a systemic inflammatory response syndrome (7,(10)(11)(12). In light of these aspects, many strategical and therapeutic approaches have been attempted in order to limit the occurrence of AKI after cardiac surgery (13).…”

mentioning

confidence: 99%

Statins and acute kidney injury following cardiac surgery: has the last word been told?

Romagnoli

Ricci

2016

J. Thorac. Dis.

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“…Acute kidney injury (AKI) is a well-known, frequent complication in patients after cardiac surgery, occurring in 7% to 40%, depending on its definition (1). Subsequently, it is independently associated with substantial morbidity [such as need for renal replacement therapy, longer length of hospital stay and progression of chronic kidney disease (CKD)] and mortality (2).…”

mentioning

confidence: 99%

Does high-dose perioperative use of statins ameliorate acute kidney injury following cardiac surgery?

Groenendael

Pickkers²

2016

J. Thorac. Dis.

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Acute kidney injury (AKI) is a well-known, frequent complication in patients after cardiac surgery, occurring in 7% to 40%, depending on its definition (1). Subsequently, it is independently associated with substantial morbidity [such as need for renal replacement therapy, longer length of hospital stay and progression of chronic kidney disease (CKD)] and mortality (2). Even a minimal increase in postoperative serum creatinine is associated with an increased mortality in cardiac surgery patients (3).Due to the complex pathophysiology of AKI with multiple contributing factors, exact mechanisms are not yet fully understood and challenges remain concerning early recognition, prevention and treatment. Currently, therapy consist of supportive measures, while numerous studies and attempts on (pharmaceutical) treatment have failed to show beneficial effects in (cardiac surgery induced) AKI (4).Lipid lowering therapy with 3-hydroxy-3-methylglutarylCoA reductase inhibitors (statins) is a widely used therapy to lower cholesterol levels and prevent cardiovascular events. Its use among patients who undergo cardiac surgery is associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery (5). Besides the lipid lowering effects of statins, established pleiotropic anti-inflammatory and endothelial stabilizing effects of statins are believed to (indirectly) contribute to this protective effect after cardiac surgery (6).As inflammatory pathways and endothelial dysfunction are also believed to play a major role in the development of AKI (7), it has been proposed that short-term use of statins could possibly improve renal outcome. Given this rationale, multiple, mostly observational, studies regarding the effect of statin use on renal outcome after cardiac surgery have been conducted and reported contradictory results. A recent meta-analysis by Wang et al., including 11 studies, showed that preoperative statin treatment reduced the incidence of post-operative AKI by 13% (8). However, the results of this meta-analysis should be interpreted with caution as the presence of supporting evidence of attenuation of AKI after cardiac surgery with preoperative statin treatment has been challenged (9). Prior studies examining specifically shortterm initiation of statins have also showed contradictory results. In a pilot randomized controlled trial (RCT) (n=100) short-term use of statins did not affect AKI incidence (10), while in a recent observational study of 17,000 patients who underwent cardiac surgery, a 22% lower relative risk for the development of AKI was observed in patients on statins in adjusted analyses (11).In this respect, Billings et al. recently tested the hypothesis that short-term high-dose perioperative use of statins would reduce AKI following cardiac surgery for both patients naïve to statin treatment and for patients already on chronic statin therapy. The primary endpoint was diagnosis of AKI according to the criteria form the acute kidney injury network (AKIN), defined by an i...

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Acute kidney injury in cardiac surgery

Cited by 75 publications

References 79 publications

Predicting cardiac surgery–associated acute kidney injury: The CRATE score

Predicting cardiac surgery–associated acute kidney injury: The CRATE score

Statins and acute kidney injury following cardiac surgery: has the last word been told?

Does high-dose perioperative use of statins ameliorate acute kidney injury following cardiac surgery?

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