Mild acute kidney injury is associated with increased mortality after cardiac surgery in patients with eGFR < 60 mL/min/1.73 m²

Abstract

Background: A small increase in serum creatinine after cardiac surgery has been associated with increased mortality. However, it is unclear whether this association varies with baseline renal function. Methods: We retrospectively reviewed data on 1359 patients who underwent cardiac surgery over a 4-year period in two tertiary care hospitals including demographic data, comorbid conditions, and intra-and postoperative complications using a standardized form. We followed patients for 90 days postoperatively and death rates and length of hospital stay were noted. Results: The incidence of acute kidney injury (AKI) after cardiac surgery was 40.2%. Patients were grouped into terciles based on change in serum creatinine. Kaplan-Meier survival analysis and Cox regression analysis showed that the development of AKI with a small increase in serum creatinine of more than 0.3 mg/dL from baseline (tercile 3) was associated with a higher risk of mortality within 90 days and 7 days longer hospitalization following a cardiac surgery. Stratified analysis showed that only patients with baseline eGFR < 60 mL/min/1.73 m 2 had fivefold higher mortality with rise of serum creatinine >0.3 mg/dL. Conclusions: Patients with baseline eGFR < 60 mL/min/1.73 m 2 had increased risk of mortality after cardiac surgery with a small increase in serum creatinine whereas a similar increase in serum creatinine in those with eGFR ≥ 60 mL/min/1.73 m 2 did not increase mortality.Mortality in cardiac surgery patients with AKI over the range of baseline eGFR 1067

Low levels of high-density lipoproteins are associated with acute kidney injury following revascularization for chronic limb ischemia

“…Although the incidence of postoperative AKI following AAA repair, and contrast-induced renal injury especially following widely performed coronary interventions has been extensively reported [6][7][8] ; however, data is limited on the incidence of AKI following peripheral endovascular and open revascularization procedures. 17 In reality, patients with symptomatic PAD are at particularly high risk for having CKD.…”

“…4,5 However, the causes of acute kidney injury is multifactorial, when embolization due to manipulation of wire and catheters during diagnostic or interventional endovascular procedures, hypotension, stress response, use of medications with possible nephrotoxic effects (antibiotics), all playing a significant role in addition to the effects of contrast nephropathy. Although post-procedural AKI has been mostly reported following coronary interventions and aneurysm repairs, [6][7][8] there is little data on AKI following open and endovascular revascularization for PAD.…”

Right ventricular systolic dysfunction and vena cava dilatation precede alteration of renal function in adult patients undergoing cardiac surgery

“…We chose to assess renal function by sCr variation, because slight elevations are frequently observed and have been demonstrated to be associated with mortality after cardiac surgery. 21,26,27 The diagnostic criteria of 540 Guinot et al Eur J Anaesthesiol 2015; 32:535-542 renal dysfunction have recently been revised. 22 The relevance of these criteria for the postcardiac surgery period has been confirmed by several studies.…”

Cardiac Surgery-Associated Acute Kidney Injury

“…Applying AKIN and RIFLE criteria, the mortality rate (hospital discharge or 30-day mortality) is between 3.8 and 54.4% in patients who develop CSA-AKI and increases progressively with the degree of renal impairment (table 1). Recent studies reported that even mild increases in sCr levels following cardiac surgery were associated with significant effects on mortality [19,20]. Furthermore, long-term survival was significantly different by AKI duration [13], and early recovery of renal function was associated with improved long-term survival after CSA-AKI [10].…”