Role of Body Mass Index in Acute Kidney Injury Patients after Cardiac Surgery

Zou, Zhouping; Zhuang, Yan; Liu, Lan; Shen, Bo; Xu, Jiacheng; Luo, Zhe; Teng, Jie; Wang, Chunsheng; Ding, Xiaoqiang

doi:10.1159/000477824

Cited by 19 publications

(19 citation statements)

References 31 publications

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“…Previous studies showed a higher risk of AKI in trauma and acute lung injury patients with higher BMI [19–21]. Others pointed out that the association between BMI and risk of AKI appeared to be a “U”-shaped curve with both under- and overweight patients being particularly at risk [22]. Billings et al speculated that the association between obesity and AKI after cardiac surgery might be mediated by oxidative stress [23].…”

Section: Discussionmentioning

confidence: 99%

Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis

et al. 2019

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BackgroundAcute kidney injury (AKI) is common in patients in the intensive care unit (ICU) and may be present on admission or develop during ICU stay. Our objectives were (a) to identify factors independently associated with the development of new AKI during early stay in the ICU and (b) to determine the risk factors for non-recovery of AKI.MethodsWe retrospectively analysed prospectively collected data of patients admitted to a multi-disciplinary ICU in a single tertiary care centre in the UK between January 2014 and December 2016. We identified all patients without AKI or end-stage renal failure on admission to the ICU and compared the outcome and characteristics of patients who developed AKI according to KDIGO criteria after 24 h in the ICU with those who did not develop AKI in the first 7 days in the ICU. Multivariable logistic regression was applied to identify factors associated with the development of new AKI during the 24–72-h period after admission. Among the patients with new AKI, we identified those with full, partial or no renal recovery and assessed factors associated with non-recovery.ResultsAmong 2525 patients without AKI on admission, the incidence of early ICU-acquired AKI was 33.2% (AKI I 41.2%, AKI II 35%, AKI III 23.4%). Body mass index, Sequential Organ Failure Assessment score on admission, chronic kidney disease (CKD) and cumulative fluid balance (FB) were independently associated with the new development of AKI. By day 7, 69% had fully recovered renal function, 8% had partial recovery and 23% had no renal recovery. Hospital mortality was significantly higher in those without renal recovery. Mechanical ventilation, diuretic use, AKI stage III, CKD, net FB on first day of AKI and cumulative FB 48 h later were independently associated with non-recovery with cumulative fluid balance having a U-shape association.ConclusionsEarly development of AKI in the ICU is common and mortality is highest in patients who do not recover renal function. Extreme negative and positive FB were strong risk factors for AKI non-recovery.

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Section: Discussionmentioning

confidence: 99%

Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis

et al. 2019

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“…AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) [ 10 ] criteria as described recently [ 11 ]: 1) Increase in serum creatinine (Scr) by ≥0.3 mg/dL (≥ 26.5 μmol/L) within 48 h; 2) Increase in Scr to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; 3) Urine volume < 0.5 mL/kg/h for 6 h and staged according to the Scr and urine output. An elevated RDW was defined as the difference between the RDW value 24 h after cardiac surgery and the latest RDW value before cardiac surgery.…”

Section: Methodsmentioning

confidence: 99%

Role of elevated red cell distribution width on acute kidney injury patients after cardiac surgery

Zou

Zhuang

Liu

et al. 2018

BMC Cardiovasc Disord

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BackgroundThe aim of the study was to explore associations between elevated red cell distribution width (RDW) and acute kidney injury (AKI) in patients undergoing cardiac surgery (CS-AKI).MethodsPreoperative, intraoperative and postoperative data of 10,274 patients undergoing cardiac surgery, including demographic data, were prospectively collected from January 2009 to December 2014. Propensity score matching was used on the basis of clinical characteristics and preoperative variables. An elevated RDW was defined as the difference between RDW 24 h after cardiac surgery and the latest RDW before cardiac surgery.ResultsA total of 10,274 patients were included in the unmatched cohort, and 3146 patients in the propensity-matched cohort. In the unmatched cohort, the overall CS-AKI incidence was 32.8% (n = 3365) with a hospital mortality of 5.5% (n = 185). In the propensity-matched cohort, the elevated RDW in AKI patients was higher than in patients without AKI (0.3% (0.0%, 0.7%) vs 0.5% (0.1, 1.1%), P < 0.001) and the elevated RDW incidences were 0.4% (0.1%, 0.9%), 0.6% (0.2%, 1.1%) and 1.1% (0.3%, 2.1%) in stage 1, 2 and 3 AKI patients (P < 0.001). Among propensity-matched patients with CS-AKI, the level of elevated RDW in non-survivors was higher than in survivors [1.2% (0.5%, 2.3%) vs 0.5% (0.1%, 1.0%), P < 0.001] and a 0.1% increase in elevated RDW was associated with a 0.24% higher risk of within-hospital mortality in patients with CS-AKI. Estimating the receiver-operating characteristic (ROC) area under the curve (AUC) showed that an elevated RDW had moderate discriminative power for AKI development (AUC = 0.605, 95% CI, 0.586–0.625; P < 0.001) and hospital mortality (AUC = 0.716, 95% CI, 0.640–0.764; P < 0.001) in the propensity-matched cohort.ConclusionsAn elevated RDW might be an independent prognostic factor for the severity and poor prognosis of CS-AKI.

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“…Overweight and obesity, analyzed by absolute weight (p = 0.035) and BMI (p <0.0001) were statistically significant in univariate analysis, and the latter was an independent risk factor for outcome in multivariate analysis (p <0.0001; OR 1.29, 95% CI 1.18 to 1.40) According to Zou et al(2018) a 5-point increase in body mass index at admission led to a 5.8% increase in the risk adjusted for the development of AKI-ACC. The pathophysiological mechanism is possibly related to insulin resistance and hyperinsulinemia of the obese patient, which leads to inadequate activation of the renin-angiotensin-aldosterone system and increased oxidative stress in the kidneys due to the effect of hormonal secretion and the release of inflammatory cytokines.…”

Section: Discussionmentioning

confidence: 96%

“…The pathophysiological mechanism is possibly related to insulin resistance and hyperinsulinemia of the obese patient, which leads to inadequate activation of the renin-angiotensin-aldosterone system and increased oxidative stress in the kidneys due to the effect of hormonal secretion and the release of inflammatory cytokines. In addition, obese patients have increased renal plasma flow and glomerular filtration, which promotes glomerular capillary hypertension, leading to structural changes in the kidneys (Zou et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for acute kidney injury in postoperative cardiac surgery

Costa

Kuchller

Botta

et al. 2021

RSD

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Objective: To evaluate the perioperative risk factors associated with postoperative AKI in patients undergoing cardiac surgery. Methodology: Between January 2011 and December 2017, we analyzed prospectively 544 patients, who were divided into two groups: patients with acute kidney injury associated with cardiac surgery (AKI-ACS) defined as an increase of 0.3 mg/dL or 1.5 times the baseline serum creatinine value and control group formed by patients without AKI-ACS. We compared patients and surgical variables using the chi-square test, Fisher's exact test, and mann-Whitney test and logistic regression. Results: AKI-ACS occurred in 29.8% of the patients. In the univariate analysis, the following variables presented a statistically significant difference: male gender (p=0.0087), age (p<0.0001), body mass (p=0.035), BMI (p=0.001), thoracic aortic surgery (p=0.029), use of extracorporeal circulation (p=0.012), CPB time (p=0.0001), aortic clamping time (p=0.0029), use of vasoactive drugs in post-operative period (p=0.017), preoperative kidney function (p<0.0001), presence of diabetes mellitus (p=0.008) and NYHA functional class (p=0.041). In the multivariate analysis, the following variables presented a statistical difference: male gender (OR 2.11), higher BMI (OR 2.11), worse preoperative renal function, demonstrated by creatinine clearance (OR 0.13), longer cardiopulmonary bypass (OR 1.008). Conclusion: The independent predictors for LRA-ACC were male gender, higher body mass index, worse preoperative renal function, and more complex surgeries associated with longer cardiopulmonary bypass.

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Role of Body Mass Index in Acute Kidney Injury Patients after Cardiac Surgery

Cited by 19 publications

References 31 publications

Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis

Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis

Role of elevated red cell distribution width on acute kidney injury patients after cardiac surgery

Risk factors for acute kidney injury in postoperative cardiac surgery

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