Influence of cardioplegic solution on the incidence of AKI after CABG procedure: del Nido cardioplegia versus HTK solution: insight of KDIGO criteria

Abstract

Background: Our hypothesis posited an association between the use of Histidine‐Tryptophan‐Ketoglutarate (HTK) solution or del Nido cardioplegia and an increased incidence of postoperative acute kidney injury (AKI) in patients undergoing coronary artery bypass grafting (CABG). Methods and Results: A retrospective study was conducted at our center, involving a total of 478 patients. Among them, 268 patients were allocated to receive the del Nido solution (DN), while 210 were placed in the HTK group. The primary focus of this study was to assess the occurrence rates of postoperative acute kidney injury (AKI) and the need for renal replacement therapy (RRT). Multivariable logistic regression was employed to examine the correlation between exposure to cardioplegic solutions and adverse kidney outcomes. Additionally, serum levels of sodium, potassium, and ionized calcium during cardiopulmonary bypass (CPB) were monitored. The occurrence of AKI showed a statistically significant difference between the two groups [(48/220 (21.81%) vs. 24/186 (12.90%), P=0.049], while the rate of RRT, although not reaching statistical significance, showed variations [(9/48, 18.75% vs. 6/24, 25%), P=0.538, respectively]. Multivariate logistic regression analysis indicated that HTK infusion is a significant risk factor for AKI. Furthermore, decreases in serum sodium and calcium levels were observed following HTK cardioplegia infusion. Conclusion: Our findings offer substantial evidence regarding the impact of the chosen cardioplegic solution on postoperative AKI rates. Enhancing cardiac arrest protocols holds significance in this context. These results pave the way for prospective studies aimed at exploring the influence of cardioplegic solutions on electrolyte imbalances in relation to postoperative AKI rates.