PREDICTORS OF ACUTE KIDNEY INJURY ASSOCIATED WITH CARDIOPULMONARY BYPASS
DOI:
https://doi.org/10.48729/pjctvs.123Abstract
Objectives: To study the incidence of acute kidney injury (AKI) in the postoperative period of cardiac surgery in patients without preoperative renal insufficiency who underwent cardiac surgery with cardiopulmonary bypass (CPB), and to explore the association between the incidence of AKI and predictors related to CPB.
Methods: Observational, cross-sectional study. Participants were divided in two groups, those who developed AKI in the postoperative period and those who did not develop AKI. Kidney Disease: Improving Global Outcomes - Clinical Practice Guideline for Acute Kidney Injury (KDIGO) classification was used to characterize AKI. The analysis included preoperative variables (anthropometric data, cardiovascular risk factors and blood parameters), as well as the type of surgery, intraoperative variables related to CPB, and postoperative creatinine variation. Association between variables was studied with binary logistic regression.
Results: We have included 329 patients, of which 62 (19%), developed AKI. There were statistically significant differences between the groups in age (p<0.001; OR (95%)-1.075 (1.037-1.114)), duration of CPB (p=0.011; 1.008 (1.002-1.014)), urine output during CPB (p=0.038; 0.998 (0.996-0.999)), mannitol and furosemide administration during CPB, (respectively, p=0.032; 2.293 (1.075-4.890) and p=0.013; 2.535 (1.214-5.296)).
Conclusions: A significant number of patients developed AKI in the postoperative period of cardiac surgery and this incidence was influenced by factors related to CPB, namely: age, duration of CPB, urine output during CPB, mannitol and furosemide administration during CPB.
Downloads
References
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.
Sampaio MC, Máximo CAG, Montenegro CM, Mota DM, Fernandes TR, Bianco ACM, et al. Comparison of diagnostic criteria for acute kidney injury in cardiac surgery. Arquivos brasileiros de cardiologia. 2013;101(1):18-25.
Goren O, Matot I. Perioperative acute kidney injury. British journal of anaesthesia. 2015;115(suppl 2):ii3-ii14.
Bove T, Monaco F, Covello RD, Zangrillo A. Acute renal failure and cardiac surgery. HSR Proceedings in Intensive Care & Cardiovascular Anesthesia. 2009;1(3):13-21.
Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, et al. Acute kidney injury after cardiac surgery focus on modifiable risk factors. Circulation. 2009;119(4):495-502.
Rodrigues AJ, Evora PRB, Bassetto S, JÚNior LA, Filho AS, Araújo WF, et al. Fatores de risco para lesão renal aguda após cirurgia cardíaca. CEP. 2009;14048:900.
Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clinical journal of the American Society of Nephrology. 2006;1(1):19-32.
Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology. 2011;114(4):964.
Kellum JA, Lameire N. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Official Journal of the International Society of Nephrology - Kidney International Supplements. 2012;2(1):1-138.
Kolh P. Renal insufficiency after cardiac surgery: a challenging clinical problem. European heart journal. 2009:ehp282.
Calvert S, Shaw A. Perioperative acute kidney injury. Perioper Med (Lond). 2012;1(6).
Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery. British journal of anaesthesia. 2012;109(suppl 1):i29-i38.
Ranucci M, Biagioli B, Scolletta S, Grillone G, Cazzaniga A, Cattabriga I, et al. Lowest Hematocrit on Cardiopulmonary Bypass Impairs the Outcome in Coronary Surgery. Texas Heart Institute Journal. 2006;33(3).
Ferraris VA, Ferraris SP, Saha SP, Hessel EA, Haan CK, Royston BD, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. The Annals of thoracic surgery. 2007;83(5):S27-S86.
Eknoyan G, Lameire N. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Official Journal of the International Society of Nephrology - Kidney International Supplements. 2013;3(1):1-163.
Michels WM, Grootendorst DC, Verduijn M, Elliott EG, Dekker FW, Krediet RT. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clinical Journal of the American Society of Nephrology. 2010;5(6):1003-9.
Pontes J, Silva GVRd, Benfatti RA, Machado NP, Pontelli R, Pontes E. Fatores de risco no desenvolvimento de insuficiência renal aguda após cirurgia de revascularização miocárdica com CEC. Rev Bras Cir Cardiovasc. 2007;22(4):484-90.
Brito DJdA, Nina VJdS, Nina RVdAH, Salgado Filho N. Prevalência e fatores de risco para insuficiência renal aguda no pós-operatório de revascularização do miocárdio. Rev bras cir cardiovasc. 2009;24(3):297-304.
Karajala V, Mansour W, Kellum JA. Diuretics in acute kidney injury. Minerva anestesiologica. 2009;75(5):251-7.
