Risk Factors Profile for Acute Kidney Injury after Cardiac Surgery Is Different According to the Level of Baseline Renal Function

Abstract

Acute kidney injury (AKI) occurs frequently after cardiac surgery. Although numerous variables were identified as predictors for AKI, there is a lack of information about possible differences in risk factors according to the level of preoperative renal function. Preoperative, intraoperative, and postoperative data from 4118 adult patients submitted to cardiac surgery from January 1, 2000, to December 31, 2005, were included in the study. AKI was defined by an increase in serum creatinine (S Cr ) ≥ 0.3 mg/dL after surgery. Patients were stratified into two groups: group 1, C Cr ≥ 60 mL/min/1.73 m 2 BSA; group 2, C Cr < 60 mL/min/1.73 m 2 BSA. Risk factors were assessed using a multiple logistic regression model. In all, 749 patients (42.5%) developed AKI. The mortality rate of the entire population was a 5.2%. In patients of group 1 (n = 2678), the variables independently associated with the onset of AKI were age, diabetes, preoperative use of diuretics, non-scheduled surgery, cardiopulmonary by-pass (CPB) time, CPB mean arterial pressure, hemodilution, and postoperative use of norepinephrine. Baseline S Cr was associated with AKI only in patients of group 2 (n = 1440). Age, EuroSCORE, non-coronary surgery, hemodilution, and postoperative use of vasoactive drugs were also predictors of AKI in this group of patients. The mortality rate was significantly higher in group 2 than group 1 (8.5% vs. 3.6%, p = 0.000). In conclusion, the present study demonstrated a difference in variables associated with postoperative AKI, according to baseline renal function. The degree of preoperative renal function was a predictor of AKI only in patients with CKD stages 3-4, as well as other risk factors. In addition to other well known risk factors for AKI in this setting, the use of diuretics in patients of group 1 and the level of hemodilution during CPB in both groups should be emphasized, as they are potentially modifiable.

Fatores de risco para lesão renal aguda após cirurgia cardíaca

“…Other important preoperative variables, such as medications in use and the condition of other organic functions -like the hepatic, hematopoietic and haemostatic functions -should be of concern, mainly in patients who have already presented preoperative renal dysfunction and/or has been enduring congestive heart failure for long time. In addition, the variables associated with postoperative AKI, as well as their value, may be different according to the preoperative baseline renal function [9,22]. However, the cost-effectiveness and practicality of a more accurate preoperative evaluation of the renal and other organic function must be considered before becoming routinely used.…”

Lesão renal aguda após revascularização do miocárdio com circulação extracorpórea

“…According to this staging, 48.5% of the patients fulfilled the criteria for AKI diagnosis, which shows a prevalence that is higher than those found in other publications. In spite of the application of the same diagnosis criteria, the AKI rates may vary considerably, ranging from 6.9 to 42.5% of incidence 1,21 . Mortality rate of the studied AKI patients was high (12.6%), reaching 55% among the patients who needed dialysis (in contrast to 1.4% of death occurrences in patients without AKI).…”

Reduced Renal Glomerular Filtration and Short- And Long-Term Prognosis in Patients After Coronary Artery Bypass Graft Surgery

“…Так, одни авторы рассматривают дисфункцию почек как небла-гоприятный фактор риска, который усугубляет ран-ний послеоперационный период и снижает выживае-мость этих больных [5,6], другие же авторы подчер-кивают положительное влияние операции АКШ для восстановления функции почек и, тем самым, улуч-шения кардиоренального прогноза [7,8]. Также осо-бый интерес представляет изучение кумулятивного эффекта ХБП и развившегося после операции ОПП на прогноз у больных, подвергнутых АКШ [5,9].…”

“…Также частота выполненных неотложных чрескожных коро-нарных вмешательств -стентирования коронарных артерий в сравниваемых группах в зависимости от наличия предшествующей ХБП и развития ОПП достоверно не отличалась (p>0,05 и ХСН II-III ФК (χ 2 =4,48; p=0,034). Эти данные сви-детельствуют о том, что наличие и выраженность поражений сердечно-сосудистой системы, ассоции-рующиеся с дисфункцией почек, являются факто-рами повышенного риска развития ОПП в раннем периоде после АКШ [6,8,9]. Также в обеих группах больных с ОПП количество выполненных сосудистых шунтов было достоверно больше, чем у больных без ОПП.…”