Logistic risk model predicting postoperative renal failure requiring dialysis in cardiac surgery patients

Rahmanian, Parwis B.; Kwiecień, Grzegorz; Langebartels, Georg; Madershahian, Navid; Wittwer, Thorsten; Wahlers, Thorsten

doi:10.1055/s-0029-1246728

Cited by 4 publications

(14 citation statements)

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“…15,[17][18][19] In our study, age, male gender, history of chronic kidney disease, previous coronary revascularization, and increasing number of comorbidities were significantly associated with an increased risk of AKI, whereas after multivariable adjustment, only lower eGFR level remained as an independent predictor, similar to some other previous studies. [20][21][22][23] In our view, despite this finding, previous identification of other risk factors apart from low eGFR warrants further studies with different patient populations to better delineate the role of lower eGFR as a sole predictor of AKI.…”

Section: Discussionsupporting

confidence: 90%

Risk Factors for Acute Kidney Injury After Hip Fracture Surgery in the Elderly Individuals

Uluçay¹,

Eren²,

Kaspar

et al. 2012

Geriatr Orthop Surg Rehabil

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Objective: We aimed to evaluate possible risk factors assocıated wıth acute kidney injury (AKI) after hip fracture surgery in the elderly individuals. Design: Level II diagnostic study, evidence obtained from prospective cohort study from 1 center with level 2, and 3 patients. Patients: A total of 165 patients (>65 years) with femoral neck fracture were enrolled in this prospective study between 2007 and 2010. Two patients were dropped for inadequate laboratory follow-up data. Patients with kidney failure or renal replacement therapy (RRT) history or AKI at admission were excluded. Intervention: Nephrology consultation was obtained from all patients at admission. All patients had undergone bipolar cemented hip arthroplasty that was performed by the same surgical team in all patients within 24 hours of fracture and admission under the same protocol. Main Outcome Measurements: Serum creatinine (SCr), urine output, and complete blood counts were evaluated at baseline and daily basis thereafter. The AKI was defined based on Acute Kidney Injury Network classification. Hospital charges were converted from Turkish Liras to US dollars and rounded. Results: Among 163 patients, AKI occurred in 25 (15.3%) patients, all within the first 48 postoperative hours. Three (1.8%) patients required RRT. Baseline SCr levels were restored within 4.84 + 1.34 days on average (3-8 days). No patient required RRT after discharge. The mean hospital stay was 3 days (2-6 days) longer and the hospital charge was 2500 US$ higher for the patients with AKI. After multivariable adjustment, only lower estimated glomerular filtration rate levels (odds ratio 0.945, 95%confidence interval 0.92-0.96) emerged as an independent predictor for AKI. Conclusion: The AKI represents a frequent complication after hip fracture surgery associated with longer hospital stay and higher treatment costs with increased morbidity. Our results show baseline renal function is an independent predictor of AKI.

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Section: Discussionsupporting

confidence: 90%

Risk Factors for Acute Kidney Injury After Hip Fracture Surgery in the Elderly Individuals

Uluçay¹,

Eren²,

Kaspar

et al. 2012

Geriatr Orthop Surg Rehabil

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“…Some have used an exposure termed "renal dysfunction" defined as preoperative serum creatinine concentration > 2 or > 2.5 mg/dL and showed that preoperative renal dysfunction is a risk marker for postoperative dialysis [7,11]. This methodology is limited by several factors relevant to the inaccuracy of serum creatinine use and the fact that a cutoff value of 2.5 mg/dL corresponds to very low renal function, that is, eGFR levels of 26 and 20 mL/min/1.73 m 2 for a 65-year-old male and female, respectively, which is the average age of such cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…During the last 2 decades, the risk profile of patients referred for cardiac surgery has substantially changed, due to population aging and due to the broad application of percutaneous coronary interventions [7,10,11]. As a result, patients who undergo cardiac procedures present with multiple comorbidities, such as congestive heart failure, peripheral vascular disease, chronic kidney disease (CKD), and diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, patients who undergo cardiac procedures present with multiple comorbidities, such as congestive heart failure, peripheral vascular disease, chronic kidney disease (CKD), and diabetes. Furthermore, the number of more complex and more demanding procedures, including multiple valve operations, aortic procedures, and combined CABG and valve operations has significantly risen [7,11,12]. These older, sicker patient populations who receive more complex interventions are at a higher risk of establishing postoperative complications, including ARF requiring renal replacement therapy (RRT) [11][12][13]; therefore, determining the potential predictors for this complication is increasingly important.…”

Section: Introductionmentioning

confidence: 99%

“…One of the most interesting questions is whether the preoperative kidney function is affecting the postoperative need for RRT. Most of the data on the field come from studies in older cohorts aiming to establish overall predictors of ARF requiring dialysis [2,9,14] or studies in which the impact of preoperative renal function was evaluated by the presence of renal dysfunction, arbitrarily defined by the authors as preoperative serum creatinine concentration > 2 or > 2.5 mg/dL [11,14].…”

Section: Introductionmentioning

confidence: 99%

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Serum Creatinine and Chronic Kidney Disease-Epidemiology Estimated Glomerular Filtration Rate: Independent Predictors of Renal Replacement Therapy following Cardiac Surgery

et al. 2018

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Background: Most studies evaluating predictors of renal replacement therapy (RRT) following cardiac surgery use arbitrary defined limits of preoperative serum creatinine. The aim of this study was to evaluate the effect of preoperative renal function using either estimated-glomerular filtration rate (eGFR) derived using Chronic Kidney Disease-Epidemiology (CKD-EPI) or serum creatinine alone as a predictor for RRT after cardiac surgery. Methods: In this prospective cohort study, baseline, intraoperative, and postoperative data of all patients who underwent an elective, urgent, or emergency cardiac surgery between 2012 and 2016 in a single center were analyzed in order to identify multivariate parameters determining the need for RRT after surgery. For preoperative renal function, we used serum creatinine levels and eGFR-derived CKD-EPI equation. We also divided our cohort into eGFR groups following the thresholds of the currently proposed CKD classification. Results: From the 1,614 patients (mean age: 65.4 ± 10.6 years; male: 77.6%) that constituted the study population, 42 (2.6%) underwent RRT postoperatively. EUROSCORE II, cardiopulmonary bypass time, cross clamp time, red blood cell (RBC) units transfused, type and urgency of surgery, combined/non combined operation, peripheral vascular disease, heart failure, chronic obstructive pulmonary disease, dyslipidemia, and preoperative renal function were all univariately associated with RRT use. Multivariate regression with bootstrap utilization indicated that CKD-EPI eGFR (OR 0.979; 95% CI 0.956–0.998), heart failure with the New York Heart Association class ≥2 (OR 4.695; 95% CI 1.756–14.061) and RBC units transfused (OR 1.287; 95% CI 1.081–1.850) were independently associated with RRT need. When serum creatinine (OR 2.920, 95% CI1.056–8.074) was used in the model, the associations with RRT were also significant. Conclusion: Preoperative renal function, defined by serum creatinine or eGFR by CKD-EPI, NYHA class II–IV, and the number of blood units transfused were all independent predictors of RRT postoperatively.

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A New Device for Intraoperative Renal Blood Flow Measurement During Open‐Heart Surgery: An Experimental Study and the Clinical Pilot Study

et al. 2013

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Renal blood flow (RBF) may vary during cardiopulmonary bypass and low flow may cause insufficient blood supply of the kidney triggering renal failure postoperatively. Still, a valid intraoperative method of continuous RBF measurement is not available. A new catheter combining thermodilution and intravascular Doppler was developed, first calibrated in an in vitro model, and the catheter specific constant was determined. Then, application of the device was evaluated in a pilot study in an adult cardiovascular population. The data of the clinical pilot study revealed high correlation between the flow velocities detected by intravascular Doppler and the RBF measured by thermodilution (Pearson's correlation range: 0.78 to 0.97). In conclusion, the RBF can be measured excellently in real time using the new catheter, even under cardiopulmonary bypass.

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Logistic risk model predicting postoperative renal failure requiring dialysis in cardiac surgery patients

Cited by 4 publications

References 0 publications

Risk Factors for Acute Kidney Injury After Hip Fracture Surgery in the Elderly Individuals

Risk Factors for Acute Kidney Injury After Hip Fracture Surgery in the Elderly Individuals

Serum Creatinine and Chronic Kidney Disease-Epidemiology Estimated Glomerular Filtration Rate: Independent Predictors of Renal Replacement Therapy following Cardiac Surgery

A New Device for Intraoperative Renal Blood Flow Measurement During Open‐Heart Surgery: An Experimental Study and the Clinical Pilot Study

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