The Incidence and Risk Factors of Acute Kidney Injury After Coronary Artery Bypass Graft Surgery
Archives of Critical Care Medicine,
Vol. 1 No. 3 (2015),
27 October 2023
Abstract
Background: Acute Kidney Injury (AKI) is a prevalent and important complication of cardiac surgery, which is associated with significant morbidity and mortality. Identification of risk factors associated with AKI will help it’s prevent.
Objectives: The objective of the present investigation was to identify risk factors for acute kidney injury in patients who underwent coronary artery bypass graft (CABG) surgery at a tertiary care center for cardiovascular patients in Iran.
Patients and Methods: From March 2014 to April 2015, 490 consecutive patients who underwent On-pump CABG at Rajaie cardio[1]vascular medical and research center were assessed. Baseline variables and perioperative data were collected and their association with the development of AKI was evaluated.
Results: Patients’ mean age was of 67.9 (SD = 12.5) years. From these patients 353 (72%) were male and 137 (28%) were female. Six deaths (1.3%) occurred among patients. Thirteen patients (2%) had AKI. The baseline serum creatinine concentrations in patients with AKI were significantly higher than other patients (P = 0.04). Volume of transfused red blood cells and hemoglobin value were different, associated with AKI (P < 0.05), while systemic arterial oxygen saturation and pressure values were not associated with AKI (P > 0.05). Mean arterial pressure (MAP) was not different in patients with AKI (P = 0.85). The mean pump time in patients with AKI was significantly higher than the other patients (P = 0.02). Postoperative Left ventricle ejection fraction (LVEF) in patients who developed AKI was significantly reduced compared with patients without AKI (P = 0.01). The in-hospital mortality of patients who developed AKI was 7.69% compared with 1.04% among those who did not (P = 0. 01).
Conclusions: Acute kidney injury is the important postoperative organ dysfunction in patients who underwent CABG and preop[1]erative elevated serum creatinine concentration, cardiopulmonary bypass time > 120 minutes, intraoperative anemia and blood transfusion were serious risk factors associated with AKI.
- Risk Factors
- Acute Kidney Injury
- Coronary Artery Bypass Grafting
How to Cite
References
Rosner MH, Okusa MD. Acute kidney injury associated with
cardiac surgery. Clin J Am Soc Nephrol. 2006;1(1):19–32. doi:
2215/CJN.00240605. [PubMed: 17699187].
Landoni G, Bove T, Crivellari M, Poli D, Fochi O, Marchetti C, et al. Acute
renal failure after isolated CABG surgery: six years of experience. Minerva Anestesiol. 2007;73(11):559–65. [PubMed: 17952028].
Fortescue EB, Bates DW, Chertow GM. Predicting acute renal failure after coronary bypass surgery: cross-validation of two riskstratification algorithms. Kidney Int. 2000;57(6):2594–602. doi:
1046/j.1523-1755.2000.00119.x. [PubMed: 10844629].
Thakar CV, Liangos O, Yared JP, Nelson D, Piedmonte MR, Hariachar S,
et al. ARF after open-heart surgery: Influence of gender and race. Am J
Kidney Dis. 2003;41(4):742–51. [PubMed: 12666060].
Thakar CV, Liangos O, Yared JP, Nelson DA, Hariachar S, Paganini
EP. Predicting acute renal failure after cardiac surgery: validation and re-definition of a risk-stratification algorithm. Hemodial
Int. 2003;7(2):143–7. doi: 10.1046/j.1492-7535.2003.00029.x. [PubMed:
.
Schopka S, Diez C, Camboni D, Floerchinger B, Schmid C, Hilker M.
Impact of cardiopulmonary bypass on acute kidney injury following
coronary artery bypass grafting: a matched pair analysis. J Cardiothorac Surg. 2014;9:20. doi: 10.1186/1749-8090-9-20. [PubMed: 24438155].
Waikar SS, Bonventre JV. Creatinine kinetics and the definition
of acute kidney injury. J Am Soc Nephrol. 2009;20(3):672–9. doi:
1681/ASN.2008070669. [PubMed: 19244578].
Bove T, Calabro MG, Landoni G, Aletti G, Marino G, Crescenzi G, et al.
The incidence and risk of acute renal failure after cardiac surgery. J
Cardiothorac Vasc Anesth. 2004;18(4):442–5. [PubMed: 15365924].
Rodrigues AJ, Evora PR, Bassetto S, Alves Junior L, Scorzoni Filho A,
Araujo WF, et al. Risk factors for acute renal failure after heart surgery.
Rev Bras Cir Cardiovasc. 2009;24(4):441–6. [PubMed: 20305915].
Wright G. Haemolysis during cardiopulmonary bypass: update. Perfusion. 2001;16(5):345–51. [PubMed: 11565889].
Baliga R, Ueda N, Walker PD, Shah SV. Oxidant mechanisms in toxic
acute renal failure. Am J Kidney Dis. 1997;29(3):465–77. [PubMed:
.
Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn
MP, et al. Acute renal failure following cardiac surgery. Nephrol Dialysis Transplant. 1999;14(5):1158–62.
Kurusz M, Davis RF, Conti VR. In: Cardiopulmonary Bypass: Principles and Practice. Gravlee GP, Davis RF, Kurusz M, Utley JR, editors.
Philadelphia: Lippincott Williams & Wilkins; 2000. Conduct of cardiopulmo cardiopulmonary bypass.
Urzua J, Troncoso S, Bugedo G, Canessa R,Munoz H, Lema G, et al. Renal
function and cardiopulmonary bypass: effect of perfusion pressure. J
Cardiothorac Vasc Anesth. 1992;6(3):299–303. [PubMed: 1610995].
Ostermann ME, Taube D, Morgan CJ, Evans TW. Acute renal failure following cardiopulmonary bypass: a changing picture. Intens Care Med.
;26(5):565–71.
Kochi AC, Martins AS, Balbi AL, Moraes EM, Lima MC, Martins LC, et al.
Preoperative risk factors for the development of acute renal failure
in cardiac surgery. Rev Bras Cir Cardiovasc. 2007;22(1):33–40. [PubMed:
.
Najafi M. Serum creatinine role in predicting outcome after cardiac
surgery beyond acute kidney injury. World J Cardiol. 2014;6(9):1006–
doi: 10.4330/wjc.v6.i9.1006. [PubMed: 25276301].
Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score
to predict acute renal failure after cardiac surgery. J Am Soc Nephrol.
;16(1):162–8. doi: 10.1681/ASN.2004040331. [PubMed: 15563569].
Armstrong T, Welsh FK, Wells J, Chandrakumaran K, John TG, Rees
M. The impact of pre-operative serum creatinine on short-term
outcomes after liver resection. HPB (Oxford). 2009;11(8):622–8. doi:
1111/j.1477-2574.2009.00094.x. [PubMed: 20495629].
Haase M, Bellomo R, Story D, Letis A, Klemz K, Matalanis G, et al. Effect of mean arterial pressure, haemoglobin and blood transfusion
during cardiopulmonary bypass on post-operative acute kidney injury.Nephrol Dial Transplant. 2012;27(1):153–60. doi: 10.1093/ndt/gfr275.
[PubMed: 21677302].
Fischer UM, Weissenberger WK, Warters RD, Geissler HJ, Allen SJ,
Mehlhorn U. Impact of cardiopulmonary bypass management on
postcardiac surgery renal function. Perfusion. 2002;17(6):401–6.
[PubMed: 12470028].
Habib RH, Zacharias A, Schwann TA, Riordan CJ, Engoren M, Durham
SJ, et al. Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit Care Med.
;33(8):1749–56. [PubMed: 16096452].
- Abstract Viewed: 7 times
- PDF Downloaded: 0 times