Global Incidence and Outcomes of Adult Patients With Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-Analysis

Hu, Jiayue; Chen, Rongyi; Liu, Shaopeng; Lei, Yu; Zou, Jianzhou; Ding, Xiaoqiang

doi:10.1053/j.jvca.2015.06.017

Cited by 228 publications

(210 citation statements)

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“…The global number of cardiac surgeries or PCI each year is approximately 2 million [28, 29] and one of the most common and serious post-operative complications is AKI. A current meta analysis found that the incidence of AKI after cardiac surgery was 22.3% around the world (95% CI 19.8-25.1) [2]. The incidence of PCI-induced AKI has been estimated between 2% and 30% depending mainly on baseline renal function, which is increasing along with the higher prevalence of CHD year by year [15, 29].…”

Section: Discussionmentioning

confidence: 99%

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Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis

Song

et al. 2017

BMC Nephrol

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BackgroundMounting evidence indicated that the elevated serum uric acid level was associated with an increased risk of acute kidney injury (AKI). Our goal was to systematically evaluate the correlation of serum uric acid (SUA) level and incidence of AKI by longitudinal cohort studies.MethodsWe searched electronic databases and the reference lists of relevant articles. 18 cohort studies with 75,200 patients were analyzed in this random-effect meta-analysis. Hyperuricemia was defined as SUA levels greater than 360-420 μmol/L (6–7 mg/dl), which was various according to different studies. Data including serum uric acid, serum creatinine, and incidence of AKI and hospital mortality were summarized using random-effects meta-analysis.ResultsThe hyperuricemia group significantly exerted a higher risk of AKI compared to the controls (odds ratio OR 2.24, 95% CI 1.76-2.86, p < 0.01). Furthermore, there is less difference of the pooled rate of AKI after cardiac surgery between hyperuricemia and control group (34.3% vs 29.7%, OR 1.24, 95% CI 0.96-1.60, p = 0.10), while the rates after PCI were much higher in hyperuricemia group than that in control group (16.0% vs 5.3%, OR 3.24, 95% CI 1.93-5.45, p < 0.01). In addition, there were significant differences in baseline renal function at admission between hyperuricemia and control groups in most of the included studies. The relationship between hyperuricemia and hospital mortality was not significant. The pooled pre-operative SUA levels were higher in AKI group than that in the non-AKI group.ConclusionsElevated SUA level showed an increased risk for AKI in patients and measurements of SUA may help identify risks for AKI in these patients.

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Section: Discussionmentioning

confidence: 99%

“…Prevention before any procedure is essential because no measures have been proven to effectively treat AKI. Therefore, if high-risk patients could be screened earlier, the clinician still would have opportunities to prevent AKI and further improve outcomes [1, 2]. …”

Section: Introductionmentioning

confidence: 99%

Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis

Song

et al. 2017

BMC Nephrol

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“…Postoperative AKI is associated with increased in-hospital mortality, with increasing severity of AKI stage correlating with worse outcomes 1-3, 17, 18 . Machado et al demonstrated that among postoperative CABG patients with elevated preoperative serum creatinine, 76% of those who developed stage 3 AKI required RRT, of which 66% died within 30 days 19 .…”

Section: Outcomes - Mortalitymentioning

confidence: 99%

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Lysak

Bïhorac

Hobson

2017

Current Opinion in Anaesthesiology

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Purpose Acute and chronic kidney diseases (AKI and CKD) have far-reaching implications for surgical patients in regards to postoperative outcomes and hospital cost. We review the recent literature on the effects of AKI and CKD on morbidity, mortality, and resource utilization among cardiac surgery patients. Recent findings Both AKI and CKD increase the risk for short and long-term mortality, morbidity, length of stay, and hospital cost among postoperative patients, with increasing disease stage correlating with worse outcomes. Even the mildest forms of AKI (RIFLE-R) and CKD (proteinuria without an observed reduction in eGFR) demonstrate worse clinical outcomes compared to patients with no AKI or CKD. Outcomes are worse even in patients who achieve full renal recovery before hospital discharge. These complications dramatically increase ICU length of stay, hospital length of stay, resource utilization, and both in-hospital and post-discharge costs, as evidenced by lower rates of discharges to home. Summary Acute and chronic kidney diseases remain prevalent, morbid, and costly conditions for cardiac surgery patients. Better risk stratification, early diagnosis, and earlier interventions are needed to prevent the consequences of these diseases.

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“…Patients undergoing cardiac surgery, especially with cardiopulmonary bypass, are at high risk for AKI. A recent meta-analysis estimated the global incidence of AKI following cardiac surgery to be approximately 22% [4]. Development of AKI following cardiac surgery increases hospital and ICU length of stage, short and long term mortality, and risk of long-term renal dysfunction [4–6].…”

Section: Introductionmentioning

confidence: 99%

Urinary TIMP-2 and IGFBP7 for the prediction of acute kidney injury following cardiac surgery

et al. 2017

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BackgroundAcute kidney injury (AKI) following cardiac surgery is common and associated with poor patient outcomes. Early risk assessment for development of AKI remains a challenge. The combination of urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) has been shown to be an excellent predictor of AKI following cardiac surgery, but reported studies are for predominately non-Asian populations.MethodsAdult patients were prospectively enrolled at Zhongshan hospital in Shanghai, China. The primary analysis was prediction of AKI and stage 2–3 AKI by [TIMP-2]*[IGFBP7] measured 4 h after postoperative ICU admission assessed using receiver operating characteristic curve (ROC) analysis. Kinetics of [TIMP-2]*[IGFBP7] following ICU admission were also examined.ResultsWe prospectively enrolled 57 cardiac surgery patients, of which 20 (35%) developed AKI and 6 (11%) developed stage 2–3 AKI. The area under the ROC curve (AUC) of [TIMP-2]*[IGFBP7] at 4 h after ICU admission was 0.80 (95% confidence interval (CI): 0.68–0.91) for development of AKI and 0.83 (95% CI: 0.69–0.96) for development of stage 2–3 AKI. Urinary [TIMP-2]*[IGFBP7] values at 4 h after ICU admission were significantly (P < 0.001) higher in patients who developed AKI than in patients who did not develop AKI (mean (standard error) of 1.08 (0.34) (ng/mL)2/1000 and 0.29 (0.05) (ng/mL)2/1000, respectively). The time-profile of [TIMP-2]*[IGFBP7] suggests the markers started to elevate by the time of ICU admission in patients who developed AKI and either decreased or remained flat in patients without AKI.ConclusionThe combination of urinary TIMP-2 and IGFBP7 4 h after postoperative ICU admission identifies patients at risk for developing AKI, not just stage 2–3 AKI following cardiac surgery.

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Global Incidence and Outcomes of Adult Patients With Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-Analysis

Cited by 228 publications

References 19 publications

Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis

Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Urinary TIMP-2 and IGFBP7 for the prediction of acute kidney injury following cardiac surgery

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