Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

Manning, Michael W.; Li, Yi-Ju; Linder, Dean; Haney, John C.; Wu, Yi-Hung; Podgoreanu, Mihai V.; Swaminathan, Madhav; Schroder, Jacob N.; Milano, Carmelo A.; Welsby, Ian J.; Stafford‐Smith, Mark; Ghadimi, Kamrouz

doi:10.1053/j.jvca.2020.11.036

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…The results of a multicenter study by Paugh and his colleagues support our findings that patients having CUF had an increased risk of AKI and further suggested about a small volume of CUF for those patients having lower CrCl to reduce the risk of developing AKI (10). Similarly a recent study proved our findings that renal injury, higher volumes of blood transfusions and longer ICU-stay were linked with higher volumes of CUF 24 . Another study revealed that routine use of CUF during cardiac surgery had no advantages in renal protection 7 .…”

Section: Discussionsupporting

confidence: 86%

“…Another study revealed that routine use of CUF during cardiac surgery had no advantages in renal protection 7 . While a recent study described that higher ultrafiltration volumes using CUF are associated with increase in postoperative CrCl values without any change in blood transfusions in cardiac surgery 24 . On the other hand Joseph et al using their hospital protocol for kidney preservation described in their study that Z-BUF along with optimal blood volume, haemoglobin and high mean arterial pressure during CPB can prevent the increase in serum creatinine level after cardiac surgery 25 .…”

Section: Discussionmentioning

confidence: 96%

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Zero Balance versus Conventional Hemofiltration-Impact on Renal Function and Blood Conservation in Adult Valvular

Haider¹,

Khwaja²,

Gull³

et al. 2021

PJMHS

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Aim: To compare conventional ultrafiltration (CUF) with zero-balanced ultrafiltration (Z-BUF) in the patients having valvular heart surgery. Methods: This cross-sectional mono-centered retrospective study was designed. The data of total 471 patients were reviewed during March 2018 to February 2020, only 98 patients fitted in the inclusion criteria and were divided into two groups with 47(47.95%) patients received CUF, while 51 (52.04%) patients were administered with Z-BUF at the Department of Cardiovascular Surgery, King Edward Medical University, Lahore, Pakistan. Statistical analysis was done using SPSS version 25. The early postoperative clinical outcomes included, renal function as primary outcome and hemodynamics stability of the patients as secondary outcome. Results: Renal functions in terms of serum creatinine (1.1 vs. 1.3mg/dL; P < 0.010) and creatinine clearance ratio (81.51vs. 67.3mL/min; P < 0.01) were improved in the patients having Z-BUF compared with CUF. Urine output was almost double in the Z-BUF cohort compared with the CUF. The hemofiltration technique had no impact on the secondary outcomes as amount of the blood loss and number of patients required blood transfusion were similar (P > 0.05) in our cohort. Conclusion: Z-BUF appeared to be better hemofiltration method than CUF during CPB when assessed in terms of renal protection without hemodynamic status in patients undergoing valvular heart surgeries in our population. Keywords: Cardiopulmonary bypass, Ultrafiltration, Renal injury, Hemoglobin, Blood transfusion

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 96%

Zero Balance versus Conventional Hemofiltration-Impact on Renal Function and Blood Conservation in Adult Valvular

Haider¹,

Khwaja²,

Gull³

et al. 2021

PJMHS

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“…When examining the trajectory pattern of perfusion flow, the separate clusters of perfusion flow at T3 measurement in our trajectory analysis implied that some patients (high-level cluster) might go through cardiac insufficiency, hemodynamic instability, or other unstable intraoperative conditions after aortic declamping and require additional mechanical assistance before weaning off from CPB. The positive effect of ultrafiltration volume on AKI risk may be another latent indicator of the congestive state of the body, as CUF is used for fluid removal to reduce fluid overload [ 26 ]. Taken together, these findings demonstrate that not only renal ischemia but also renal congestion plays a vital role in worsening kidney function.…”

Section: Discussionmentioning

confidence: 99%

Prediction of acute kidney injury after cardiac surgery: model development using a Chinese electronic health record dataset

et al. 2022

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Background Acute kidney injury (AKI) is a major complication following cardiac surgery that substantially increases morbidity and mortality. Current diagnostic guidelines based on elevated serum creatinine and/or the presence of oliguria potentially delay its diagnosis. We presented a series of models for predicting AKI after cardiac surgery based on electronic health record data. Methods We enrolled 1457 adult patients who underwent cardiac surgery at Nanjing First Hospital from January 2017 to June 2019. 193 clinical features, including demographic characteristics, comorbidities and hospital evaluation, laboratory test, medication, and surgical information, were available for each patient. The number of important variables was determined using the sliding windows sequential forward feature selection technique (SWSFS). The following model development methods were introduced: extreme gradient boosting (XGBoost), random forest (RF), deep forest (DF), and logistic regression. Model performance was accessed using the area under the receiver operating characteristic curve (AUROC). We additionally applied SHapley Additive exPlanation (SHAP) values to explain the RF model. AKI was defined according to Kidney Disease Improving Global Outcomes guidelines. Results In the discovery set, SWSFS identified 16 important variables. The top 5 variables in the RF importance matrix plot were central venous pressure, intraoperative urine output, hemoglobin, serum potassium, and lactic dehydrogenase. In the validation set, the DF model exhibited the highest AUROC (0.881, 95% confidence interval [CI] 0.831–0.930), followed by RF (0.872, 95% CI 0.820–0.923) and XGBoost (0.857, 95% CI 0.802–0.912). A nomogram model was constructed based on intraoperative longitudinal features, achieving an AUROC of 0.824 (95% CI 0.763–0.885) in the validation set. The SHAP values successfully illustrated the positive or negative contribution of the 16 variables attributed to the output of the RF model and the individual variable’s effect on model prediction. Conclusions Our study identified 16 important predictors and provided a series of prediction models to enhance risk stratification of AKI after cardiac surgery. These novel predictors might aid in choosing proper preventive and therapeutic strategies in the perioperative management of AKI patients.

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“…10 In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Manning et al presented the findings of a singlecenter retrospective study of 1,641 adults who underwent elective cardiac surgery with conventional ultrafiltration (CUF) performed during CPB and its effects on blood transfusion requirements and the risk of developing postoperative AKI. 11 The study found that excessive weight-indexed CUF volume removal exceeding 32 mL/kg was significantly associated with an increased incidence of AKI and greater AKI severity at the time of diagnosis. In addition, CUF volume removal of any amount did not reduce the need for allogeneic blood transfusion; but rather, greater CUF volumes were associated with higher transfusion volumes.…”

mentioning

confidence: 91%

“…18 The findings of the study by Manning et al highlighted several important clinical observations, namely that excessive CUF volume removal is associated with AKI; CUF has no beneficial role in mitigating blood product usage; and perhaps, more interestingly, that a higher incidence of transfusion was seen with increasing CUF volume removal. 11 The latter warrants further investigation. However, one must bear in mind that this was a retrospective study that only could determine association and not causation.…”

mentioning

confidence: 93%

Conventional Ultrafiltration—No More Role in Elective Adult Cardiac Surgery?

Phoon

Hwang

2021

Journal of Cardiothoracic and Vascular Anesthesia

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Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

Cited by 17 publications

References 23 publications

Zero Balance versus Conventional Hemofiltration-Impact on Renal Function and Blood Conservation in Adult Valvular

Zero Balance versus Conventional Hemofiltration-Impact on Renal Function and Blood Conservation in Adult Valvular

Prediction of acute kidney injury after cardiac surgery: model development using a Chinese electronic health record dataset

Conventional Ultrafiltration—No More Role in Elective Adult Cardiac Surgery?

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