Risk factor for acute kidney injury in patients with chronic kidney disease receiving valve surgery with cardiopulmonary bypass
Journal
Asian Journal of Surgery
Journal Volume
44
Journal Issue
1
Pages
229-234
Date Issued
2021
Author(s)
Abstract
Introduction: Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) in patients with pre-existing impaired renal function carries deleterious outcomes but is not frequently evaluated. The optimal CPB strategy for preventing AKI in this vulnerable patient group is still controversial. Methods: A total of 156 patients with preoperative estimated glomerular filtration rate (e-GFR) <30 ml/min but not on chronic dialysis receiving valve operation under CPB were included in the present study. Postoperative AKI was defined as KDIGO (Kidney Disease Improving Global Outcomes) stage 3. Hospital mortality and two-year renal function evolution were compared between patients with postoperative AKI and those without AKI. Risk factors for the development of postoperative AKI were also studied. Results: The incidence of postoperative KDIGO-3 was high (44.2%). Hospital mortality was higher in the AKI group (30.4%) than in the non-AKI group (8.0%). Among the hospital survivors, renal function deterioration to permanent dialysis at two years was also more common in AKI group (14.5%) than in non-AKI group (4.6%). Univariate logistic regression for postoperative AKI revealed male gender, increased age, height, weight, BSA, and BMI, high preoperative serum creatinine, prolonged CPB duration, and decreased CPB target temperature as risk factors. However, multivariate analysis revealed only high preoperative serum creatinine and decreased CPB target temperature as significant risk factors for postoperative AKI. Conclusion: To prevent postoperative AKI in CKD patients, low CPB target temperature is avoided, especially for those with high preoperative serum creatinine levels. ? 2020
SDGs
Other Subjects
creatinine; acute kidney failure; adverse event; aged; blood; cardiopulmonary bypass; chronic kidney failure; complication; female; heart surgery; human; incidence; male; middle aged; postoperative complication; risk factor; temperature; very elderly; Acute Kidney Injury; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Creatinine; Female; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Renal Insufficiency, Chronic; Risk Factors; Temperature
Publisher
Elsevier (Singapore) Pte Ltd
Type
journal article