Comparison of predicted with measured creatinine clearance in cardiac surgical patients

Bloor, G.K.; Welsh, K. R.; Goodall, Shannon; Shah, M.V.

doi:10.1016/s1053-0770(96)80053-x

Cited by 17 publications

(3 citation statements)

References 13 publications

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“…18 During the postoperative period, however, these estimates may not be accurate because of imbalances between creatinine production and elimination, which can be caused by various factors, including changing renal function, muscle breakdown and injury, liver dysfunction, and various medications. 50 Second, because only patients undergoing cardiac surgery with CPB were included in the present study, our results cannot be generalized to other populations. Third, because this was a retrospective observational study, causality could not be determined.…”

Section: Study Limitationsmentioning

confidence: 98%

Acute Kidney Injury After Cardiac Surgery

et al. 2009

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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.)

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Section: Study Limitationsmentioning

confidence: 98%

Acute Kidney Injury After Cardiac Surgery

et al. 2009

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“…Second, postoperative renal function was estimated with the change of serum creatinine. During postoperative period, however, these estimates may not be accurate because of imbalances between creatinine production and elimination, which could be caused by many factors, including changing renal function, muscle breakdown and injury, liver dysfunction, and various medications [46].…”

Section: Discussionmentioning

confidence: 99%

The Association between Atherosclerotic Renal Artery Stenosis and Acute Kidney Injury in Patients Undergoing Cardiac Surgery

Yang

et al. 2013

PLoS ONE

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BackgroundAtherosclerotic renal artery stenosis (ARAS) and coronary artery disease (CAD) commonly co-exist. Some patients with unidentified ARAS may undergo cardiac surgery. While acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery, we aim to evaluate the influence of ARAS on the occurrence of postoperative AKI in patients with normal or near-normal baseline renal function following cardiac surgery.MethodsA total of 212 consecutive patients undergoing aortography after coronary angiography and cardiac surgery were retrospectively studied for their preoperative and intraoperative conditions. AKI was defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg/dl (≥26.4 µmol/l) or a percentage increase in creatinine of more than or equal to 50% (1.5-fold from baseline) after cardiac surgery. A propensity score-adjusted logistic regression models was used in estimating the effect of ARAS on the risk of postoperative AKI.ResultsARAS (≥50%) was observed in 50 (23.6%) patients, and 83 (39.2%) developed AKI after cardiac surgery. A correlation existed between renal artery patency and preoperative–to–postoperative %ΔCr in patients with ARAS (r = 0.297, P<0.0001). The propensity score-adjusted regression model showed the occurrence of postoperative AKI in patients with ARAS was significantly higher than those without ARAS (OR 2.858, 95% CI 1.260–6.480, P = 0.011).ConclusionARAS is associated with postoperative AKI in patients with normal or near-normal baseline renal function after cardiac surgery.

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“…Kidneys that did not function immediately might recover with longer time (as in DGF). Conversely, kidneys that function immediately after transplant will function indefinitely depending on prevention of rejection; (4) CrCl was measured using a 4-h timed collection, not the clinical standard based on a 24-h urine sample collection, but Bloor et al, proposed that when healthy subjects with normal renal function preoperative (such as the scenario of our study) are used a 4-h CrCl prediction method correlates with CrCl measurement (37). In a different model, we have reported that room temperature perfusion is equivalent to perfusion at 37 • .…”

Section: Ecs Effects On Renal Function In Dcd Graftsmentioning

confidence: 99%

Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac Death

Rojas-Pena

Reoma

Krause

et al. 2010

American Journal of Transplantation

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Donors after cardiac death (DCD) could increase the organ pool. Data supports good long-term renal graft survival. However, DCDs are <10% of deceased donors in the United States, due to delayed graft function, and primary nonfunction. These complications are minimized by extracorporeal support after cardiac death (ECS-DCD). This study assesses immediate and acute renal function from different donor types. DCDs kidneys were recovered by conventional rapid recovery or by ECS, and transplanted into nephrectomized healthy swine. Warm ischemia of 10 and 30 min were evaluated. Swine living donors were controls (LVD). ECS-DCDs were treated with 90 min of perfusion until organ recovery. After procurement, kidneys were cold storage 4-6 h. Renal vascular resistance (RVR), urine output (UO), urine protein concentration (UrPr) and creatinine clearance (CrCl), were collected during 4 h posttransplantation. All grafts functioned with adequate renal blood flow for 4 h. RVR at 4 h posttransplant returned to baseline only in the LVD group (0.36 mmHg/mL/min ± 0.03). RVR was higher in all DCDs (0.66 mmHg/mL/min ± 0.13), without differences between them. UO was >50 mL/h in all DCDs, except in DCD-30 (6.8 mL/h ± 1.7). DCD-30 had lower CrCl (0.9 mL/min ± 0.2) and higher UrPr >200 mg/dL, compared to other DCDs >10 mL/min and <160 mg/dL, respectively. Normothermic ECS can resuscitate kidneys to transplantable status after 30 min of cardiac arrest/WI.

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Comparison of predicted with measured creatinine clearance in cardiac surgical patients

Cited by 17 publications

References 13 publications

Acute Kidney Injury After Cardiac Surgery

Acute Kidney Injury After Cardiac Surgery

The Association between Atherosclerotic Renal Artery Stenosis and Acute Kidney Injury in Patients Undergoing Cardiac Surgery

Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac Death

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