Predictors of nephrological morbidity after coronary artery bypass surgery

Janssen, D.P.B.; Noyez, Luc; Druten, J.A.M. van; Skotnicki, S.H.; Lk, Lacquet

doi:10.1016/s0967-2109(01)00134-x

Cited by 17 publications

(29 citation statements)

References 8 publications

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“…15 Nephrological morbidity was defined as dialysis or creatinine Ն150 (mol/L). They identified similar preoperative risk factors to our model: age Ն75, diabetes, and hypertension.…”

Section: Discussionmentioning

confidence: 99%

Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery

et al. 2007

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Background-Renal insufficiency after coronary artery bypass graft (CABG) surgery is associated with increased short-term and long-term mortality. We hypothesized that preoperative patient characteristics could be used to predict the patient-specific risk of developing postoperative renal insufficiency. Methods and Results-Data were prospectively collected on 11 301 patients in northern New England who underwent isolated CABG surgery between 2001 and 2005. Based on National Kidney Foundation definitions, moderate renal insufficiency was defined as a GFR Ͻ60 mL/min/1.73m 2 and severe renal insufficiency as a GFR Ͻ30. Patients with at least moderate renal insufficiency at baseline were eliminated from the analysis, leaving 8363 patients who became our study cohort. A prediction model was developed to identify variables that best predicted the risk of developing severe renal insufficiency using multiple logistic regression, and the predictive ability of the model quantified using a bootstrap validated C-Index (Area Under ROC) and Hosmer-Lemeshow statistic. Three percent of the patients with normal renal function before CABG surgery developed severe renal insufficiency (229/8363). In a multivariable model the preoperative patient characteristics most strongly associated with postoperative severe renal insufficiency included: age, gender, white blood cell count Ͼ12 000, prior CABG, congestive heart failure, peripheral vascular disease, diabetes, hypertension, and preoperative intraaortic balloon pump. The predictive model was significant with 2 150.8, probability value Ͻ0.0001. The model discriminated well, ROC 0.72 (95%CI: 0.68 to 0.75). The model was well calibrated according to the Hosmer-Lemeshow test. Conclusions-We developed a robust prediction rule to assist clinicians in identifying patients with normal, or near normal, preoperative renal function who are at high risk of developing severe renal insufficiency. Physicians may be able to take steps to limit this adverse outcome and its associated increase in morbidity and mortality.

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“…15 Nephrological morbidity was defined as dialysis or creatinine Ն150 (mol/L). They identified similar preoperative risk factors to our model: age Ն75, diabetes, and hypertension.…”

Section: Discussionmentioning

confidence: 99%

Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery

et al. 2007

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“…The metrics most commonly used to define AKI are the absolute or relative serum creatinine level and/or the need for dialysis in previously undialyzed patients. Table 1 [1,2,3,4,8,11,12,13,14,15,16,17,18] shows the range of metrics used in recent studies involving cardiac surgery patients and the corresponding incidence of AKI. Attempts to promote the use of consistent criteria for the definition of AKI resulted in the publication of the Acute Dialysis Quality Initiative Group’s Risk, Injury, Failure, Loss of Kidney Function, End-Stage Kidney Disease criteria, which were subsequently modified to create the Acute Kidney Injury Network criteria [19,20].…”

Section: Incidence Of Aki After Cardiac Surgerymentioning

confidence: 99%

“…However, the true nature of the trends reported is obscured by changes in the definition of AKI and in the demographics of the at-risk population. For example, using a consistent definition of postoperative renal dysfunction, Janssen et al [3] documented a gradual increase in the incidence of this condition in Dutch CABG patients between 1987 (0.6%) and 1995 (3.4%). This increase was associated with increases in patient age and in the prevalence of diabetes and preexisting renal pathology [3], suggesting that changes in patient population may explain the increased incidence.…”

Section: Incidence Of Aki After Cardiac Surgerymentioning

confidence: 99%

“…For example, using a consistent definition of postoperative renal dysfunction, Janssen et al [3] documented a gradual increase in the incidence of this condition in Dutch CABG patients between 1987 (0.6%) and 1995 (3.4%). This increase was associated with increases in patient age and in the prevalence of diabetes and preexisting renal pathology [3], suggesting that changes in patient population may explain the increased incidence. In contrast, a British study [4] found that the percentage of cardiopulmonary bypass patients who required continuous venovenous hemofiltration decreased between 1989/1990 (2.7%) and 1997/1998 (2.0%).…”

Section: Incidence Of Aki After Cardiac Surgerymentioning

confidence: 99%

“…There has been little progress in recent years in reducing the incidence of this condition, improving the prognosis of affected patients, or identifying it earlier in its pathological course [2,3,4]. Although the persistent morbidity and mortality of perioperative AKI may reflect increased baseline mortality risk among cardiac surgery patients [2,5], it is vital that we work to identify predisposing factors and develop safer perioperative protocols.…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

et al. 2011

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Background/Aims: Patients who develop acute kidney injury (AKI) after cardiac surgery continue to have a high mortality rate. Although factors that predispose to postoperative renal dysfunction have been identified, this knowledge has not been associated with a substantial reduction in the incidence of this serious adverse event. Methods: This review uses the existing literature to explore the relationship between AKI and perioperative blood pressure (BP) control in cardiac surgery patients. The results of recent novel analyses are introduced, and the implications of these studies for the management of cardiac surgery patients in the perioperative period are discussed. Results: Preexisting isolated systolic hypertension and wide pulse pressure increase the risk of postoperative renal dysfunction in the cardiac surgery population. New data suggest that BP lability (i.e., BP excursions outside an acceptable physiologic range) during cardiac surgery may also be an important predictor of subsequent renal dysfunction. Conclusion: Recently published data suggest that perioperative BP lability influences both the risk of postoperative renal dysfunction and 30-day mortality. Future studies will determine whether the use of agents that allow improved BP control within a desirable range will reduce the incidence of postoperative AKI in cardiac surgery patients.

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Decreased mean perfusion pressure as an independent predictor of acute kidney injury after cardiac surgery

Kalam

Broad

et al. 2020

Heart Vessels

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Acute kidney injury after cardiac surgery (AKICS) is common. Previous studies examining the role that mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) may have on AKICS have not taken into account how baseline central venous pressure (CVP) and mean perfusion pressure (MPP) (i.e. MAP − CVP) can influence its evolution. To assess whether the change in MPP to the kidneys (i.e. delta MPP or DMPP) during CPB compared to baseline is an independent predictor of AKICS. After ethical approval, a retrospective observational study was performed on all patients undergoing CPB between October 2013 and June 2015 at a university-affiliated hospital. Known risk factors for the development of AKICS were recorded, as were the MPP values at baseline and during CPB. From this, statistical modelling was performed to identify predictors of postoperative AKICS. 664 patients were identified. Analysis was performed on 513 patients after exclusion. On logistic regression, significant and independent predictors of AKICS included: d20DMPP (cumulative duration of MPP values during CPB that were 20% below baseline and exceeded three consecutive minutes) (P = 0.010); baseline CVP; age; pre-operative creatinine level; and left ventricular (LV) dysfunction (ejection fraction (EF) < 45%). On alternative modelling, the cumulative number of MPP values during CPB that were 10% below baseline was also independently associated with AKICS (P = 0.003). Modelling without taking into account CVP also supported this association. The duration of differences in perfusion pressure to the kidneys during CPB compared to baseline is an independent predictor of AKICS.

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Predictors of nephrological morbidity after coronary artery bypass surgery

Cited by 17 publications

References 8 publications

Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery

Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

Decreased mean perfusion pressure as an independent predictor of acute kidney injury after cardiac surgery

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