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Cardiac surgery-related acute kidney injury - risk factors, clinical course, management suggestions

Item Type:Article
Title:Cardiac surgery-related acute kidney injury - risk factors, clinical course, management suggestions
Creators Name:Just, I.A. and Alborzi, F. and Godde, M. and Ott, S. and Meyer, A. and Stein, J. and Mazgareanu, S. and van der Giet, M. and Schmidt-Ott, K.M. and Falk, V. and Schoenrath, F.
Abstract:OBJECTIVE: Acute kidney injury (AKI) is a common complication after cardiac surgery (CS). Since a therapeutic regime remains scarce, an early implementation of preventive strategies is crucial. We investigated risk factors and the typical clinical course of CS-associated AKI (CS-AKI) to derive strategies for perioperative clinical routine. DESIGN: Retrospective data analysis. SETTING: The data were collected from clinical routine in a maximum care university hospital. PARTICIPANTS: Patients. INTERVENTIONS: We retrospectively analyzed data from 538 patients who underwent CS. MEASUREMENTS AND MAIN RESULTS: The median age of the 466 patients included was 66.6 years; 65.7% were male. AKI occurred in 131 (28.1%) patients, mainly (89.0%) starting within 72 hours postoperatively. 31 (6.7%) patients showed KDIGO AKI stage 3. AKI was significantly more frequent in patients with chronic kidney disease (p<0.001), emergency admission (p<0.001), heart failure (p<0.001) and if postoperative complications occurred (p<0.001). In a multivariable analysis, postoperative CS-AKI risk significantly decreases with each 1 or 10 ml/min preoperative glomerular filtration rate (GFR) (OR 0.962 and 0.677;95% CI 0.947-0.977 and 0.577-0.793;p<0.001 and p<0.0001). Only in patients who developed KDIGO AKI stage 3, a trend to decreased GFR and increased creatinine levels was observed early postoperatively. CONCLUSIONS: Especially in patients with preexisting CKD and signs of CS-AKI occurring on the day of surgery, close monitoring of renal function should be performed for at least 72 hours after CS to detect an onset of AKI early and initiate renal protective strategies. An optimal preoperative fluid management might prevent postoperative AKI.
Keywords:Acute Kidney Injury, Cardiac Surgery-Related Acute Kidney Injury, Cardiac Surgery, Postoperative Renal Failure, Early Detection
Source:Journal of Cardiothoracic and Vascular Anesthesia
Date:14 May 2021
Official Publication:https://doi.org/10.1053/j.jvca.2021.05.012
PubMed:View item in PubMed

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