Prediction and Prevention of Acute Kidney Injury after Cardiac Surgery

Shin, Su Rin; Kim, Dong Joon; Shin, Il Woo; Sohn, Ju-Tae

doi:10.1155/2016/2985148

Cited by 42 publications

(44 citation statements)

References 104 publications

(96 reference statements)

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“…Hemodialysis may be initiated early 49 or pharmacologic interventions that may protect renal function can be considered. 31 The combination of renin-angiotensin system inhibitors, nonsteroidal anti-inflammatory drugs and/or diuretics, which is known to be nephrotoxic, should be avoided if possible. 50 As volume overload may develop in patients with renal dysfunction, strict control of fluid administration and avoidance of aggressive fluid intake could potentially mitigate postoperative AKI.…”

Section: Discussionmentioning

confidence: 99%

“…We defined AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria: 30 serum creatinine (sCr) increased ≥1.5-fold or increased by ≥0.3 mg/dL from the baseline within 7 postoperative days. 30, 31 To evaluate whether a preoperative E/e′ ratio >15 is associated with poor clinical outcomes, the following secondary outcome variables were investigated: need for postoperative continuous venovenous hemodialysis, extubation time, the length of hospital and intensive care unit stays, postoperative new-onset atrial fibrillation and inhospital and 1-year all-cause mortality rates.…”

Section: Outcome Variable and Associated Comorbiditiesmentioning

confidence: 99%

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Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

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Nam

et al. 2018

Circ J

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and mortality. 4,9 Hemodynamic disturbance during OPCAB has been reported to have a biventricular contribution, and the major cause is believed to be diastolic dysfunction and abnormal filling of both ventricles. 10,11 As such, it is possible that an underlying increased LVFP may aggravate the intraoperative hemodynamic disturbance, resulting in a higher rate of postoperative AKI. Although previous studies have reported the effect of diastolic dysfunction on postoperative outcomes, including death or major adverse cardiac events (MACE), 4,12 postoperative renal dysfunction was evaluated only as a secondary outcome and the association between increased LVFP in patients with normal LV systolic function and postoperative AKI has not been fully evaluated.The ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e′) has been reported to have good predictive power for mean LV diastolic pressure or mean LVFP and has been used to estimate the diastolic function of the heart. 13,14 E/e′ >15 is P erioperative acute kidney injury (AKI) has been reported to be an important contributor to postoperative morbidity and mortality especially after cardiovascular surgery, including coronary artery bypass graft (CABG). 1,2 Off-pump coronary artery bypass surgery (OPCAB) has been associated with less severe and a lower incidence of AKI compared with on-pump CABG. 3 Nonetheless, there is still a substantial incidence of AKI after OPCAB and it is caused by transient circulatory arrest, global hypoperfusion, myocardial ischemia-reperfusion injury, and inflammatory response. 3 The incidence of diastolic dysfunction in patients who undergo CABG has been reported as high. 4,5 Although many studies have reported systolic dysfunction of the heart as a risk factor for postoperative AKI, 6,7 the association between preoperative diastolic dysfunction and postoperative AKI has not been investigated. A stiff left ventricle with low compliance would lead to an elevated LV filling pressure (LVFP), 8 which is associated with higher morbidity Background: The ratio of the early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an echocardiographic index of mean left ventricular (LV) filling pressure. We investigated the association between the preoperative E/e′ ratio and postoperative acute kidney injury (AKI) during off-pump coronary artery bypass surgery (OPCAB).

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Section: Discussionmentioning

confidence: 99%

Section: Outcome Variable and Associated Comorbiditiesmentioning

confidence: 99%

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Hur

Nam

et al. 2018

Circ J

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“…However, diagnostic criteria using sCr change including the KDIGO criteria were validated in pediatric patients including neonates by demonstrating the association between AKI and clinical outcomes [20, 25]. Fourth, AKI was determined according to the KDIGO criteria using increase in sCr of more than 1.5 times the baseline up to seven days in the present study [47]. A further time beyond 48 hours following cardiac surgery makes AKI to be less likely a result of preoperative and operative variables and more likely to be due to secondary factors or insults post-operatively that either lead to development of AKI or progression of AKI that occurred due to pre-op and operative factors.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

et al. 2016

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Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high morbidity and mortality. Modifiable risk factors for postoperative AKI including perioperative anesthesia-related parameters were assessed. The authors conducted a single-center, retrospective cohort study of 220 patients (aged 10 days to 19 years) who underwent congenital cardiac surgery between January and December 2012. The incidence of AKI within 7 days postoperatively was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Ninety-two patients (41.8%) developed AKI and 18 (8.2%) required renal replacement therapy within the first postoperative week. Among patients who developed AKI, 57 patients (25.9%) were KDIGO stage 1, 27 patients (12.3%) were KDIGO stage 2, and eight patients (3.6%) were KDIGO stage 3. RACHS-1 (Risk-Adjusted classification for Congenital Heart Surgery) category, perioperative transfusion and fluid administration as well as fluid overload were compared between patients with and without AKI. Multivariable logistic regression analyses determined the risk factors for AKI. AKI was associated with longer hospital stay or ICU stay, and frequent sternal wound infections. Younger age (<12 months) [odds ratio (OR), 4.01; 95% confidence interval (CI), 1.77–9.06], longer cardiopulmonary bypass (CPB) time (OR, 2.45; 95% CI, 1.24–4.84), and low preoperative hemoglobin (OR, 2.40; 95% CI, 1.07–5.40) were independent risk factors for AKI. Fluid overload was not a significant predictor for AKI. When a variable of hemoglobin concentration increase (>3 g/dl) from preoperative level on POD1 was entered into the multivariable analysis, it was independently associated with postoperative AKI (OR, 6.51; 95% CI, 2.23–19.03 compared with no increase). This association was significant after adjustment with patient demographics, medication history and RACHS-1 category (hemoglobin increase >3g/dl vs. no increase: adjusted OR, 6.94; 95% CI, 2.33–20.69), regardless of different age groups and cyanotic or non-cyanotic heart disease. Prospective trials are required to evaluate whether correction of preoperative anemia and prevention of hemoconcentration may ameliorate postoperative AKI in patients who underwent congenital cardiac surgery.

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“…Various agents, including dopamine, fenoldopam, statins, sodium bicarbonate, mannitol, N-acetylcysteine, atrial natriuretic peptide and free hemoglobin scavengers, have been proposed as agents providing pharmacologic renal protection [16][17][18][19]. However, the results of studies in which the impact of such pharmacologic renal protection was assessed have not been consistent.…”

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confidence: 99%

“…Numerous risk factors have been reported, including advanced age, anemia, diabetes, chronic lung disease, chronic heart failure, chronic renal dysfunction, administration patients who have undergone CVS [16][17][18][19], but as yet no definitive strategy to prevent AKI has been identified. Considering the multiple pathophysiologies of AKI post-CVS, it is possible that the prevention of AKI in this context can not be achieved through a single intervention [20].…”

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confidence: 99%