Determinants of Acute Kidney Injury Duration After Cardiac Surgery: An Externally Validated Tool

Abstract

Background Acute kidney injury (AKI) duration following cardiac surgery is associated with poor survival in a dose-dependent manner. However, it is not known what peri-operative risk factors contribute to prolonged AKI and delayed recovery. We sought to identify peri-operative risk factors that predict duration of AKI, a complication that effects short and long term survival. Methods We studied 4,987 consecutive cardiac surgery patients from 2002 through 2007. AKI was defined as a ≥0.3 (mg/dL) or ≥50% increase in SCr from baseline. Duration of AKI was defined by the number of days AKI was present. Step-wise multivariable negative binomial regression analysis was conducted using peri-operative risk factors for AKI duration. C-index was estimated by Kendall’s tau. Results AKI developed in 39% of patients with a median duration of AKI at 3 days and ranged from 1 to 108 days. Patients without AKI had duration of zero days. Independent predictors of AKI duration included baseline patient and disease characteristics, operative and post-operative factors. Prediction for mean duration of AKI was developed using coefficients from the regression model and externally validated the model on 1,219 cardiac surgery patients in a separate cardiac surgery cohort (TRIBE-AKI). The C-index was 0.65 (p<0.001) for the derivation cohort and 0.62 (p<0.001) for the validation cohort. Conclusion We identified and externally validated peri-operative predictors of AKI duration. These risk-factors will be useful to evaluate a patient’s risk for the tempo of recovery from AKI after cardiac surgery and subsequent short and long term survival. The level of awareness created by working with these risk factors have implications regarding positive changes in processes of care that have the potential to decrease the incidence and mitigate AKI.

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

“…However, clinical risk scores for persistent AKI have not been validated for general use and the risk factors that contribute to persistent AKI, AKD, and delayed recovery among hospitalized patients are not known. Several studies have identified clinical risk scores, biomarkers, imaging, and functional tests to differentiate rapid reversal of AKI from persisting AKI [19][20][21][22][23][24][25][26][27] (see Supplementary information S2 (table)). In the opinion of the ADQI workgroup, these tools would likely work well together and are a recommended area of future research…”

Postępowanie w okresie okołooperacyjnym u chorych z ryzykiem wystąpienia ostrego uszkodzenia nerek, poddawanych operacjom kardiochirurgicznym

“…Zidentyfikowano dotąd kilkanaście potencjalnych czynników ryzyka CSA-AKI, do których można zaliczyć obciąże-nia przedoperacyjne (starszy wiek, cukrzycę, nikotynizm oraz podwyższone wyjściowe stężenie kreatyniny), czynniki śródoperacyjne (konieczność zastosowania leków inotrpowych, konieczność przetoczeń preparatów krwi, czas zakleszczenia aorty oraz konieczność ponownego zastosowania krążenia pozaustrojowego), te związane z okresem CPB, cardiopulmonary by-pass (diurezę podczas CPB oraz fakt zastosowania furosemidu podczas CPB) oraz 5 parametrów pooperacyjnych (konieczność transfuzji, użycie diuretyków, leków wazokonstrykcyjnych, inotropowych oraz antyartymicznych) [20,21]. Najnowsza metaanaliza przeprowadzona przez Kumar i wsp.…”

Recuperação cirúrgica retardada: análise do conceito

“…Attribute 2 -Impairment of physiological functions: comprises the domains of physiological functions: impaired elimination, cardiovascular complications, impaired structural integrity (complication related to the surgical wound healing phases), breathing complications, digestive and sexual dysfunction. These domains are manifested by signs and symptoms that have an impact on patients' lives, hindering the recovery to the same condition as in the preoperative period (16)(17)(18) . The impaired structural integrity is an expressive domain in literature.…”