BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is a major health issue. Lacking effective therapies, risk factor modification may offer a means of preventing this complication. The objective of the present study was to identify and determine the prognostic importance of such risk factors. METHODS AND RESULTS: Data from a multicenter cohort of 3500 adult patients who underwent cardiac surgery at 7 hospitals during 2004 were analyzed (using multivariable logistic regression modeling) to determine the independent relationships between 3 thresholds of AKI (>25%, >50%, and >75% decrease in estimated glomerular filtration rate within 1 week of surgery or need for postoperative dialysis) with death rates, as well as to identify modifiable risk factors for AKI. The 3 thresholds of AKI occurred in 24% (n=829), 7% (n=228), and 3% (n=119) of the cohort, respectively. All 3 thresholds were independently associated with a >4-fold increase in the odds of death and could be predicted with several perioperative variables, including preoperative intra-aortic balloon pump use, urgent surgery, and prolonged cardiopulmonary bypass. In particular, 3 potentially modifiable variables were also independently and strongly associated with AKI. These were preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration. CONCLUSIONS: AKI after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication.
BACKGROUND:Acute kidney injury (AKI) after cardiac surgery is a major health issue. Lacking effective therapies, risk factor modification may offer a means of preventing this complication. The objective of the present study was to identify and determine the prognostic importance of such risk factors. METHODS AND RESULTS: Data from a multicenter cohort of 3500 adult patients who underwent cardiac surgery at 7 hospitals during 2004 were analyzed (using multivariable logistic regression modeling) to determine the independent relationships between 3 thresholds of AKI (>25%, >50%, and >75% decrease in estimated glomerular filtration rate within 1 week of surgery or need for postoperative dialysis) with death rates, as well as to identify modifiable risk factors for AKI. The 3 thresholds of AKI occurred in 24% (n=829), 7% (n=228), and 3% (n=119) of the cohort, respectively. All 3 thresholds were independently associated with a >4-fold increase in the odds of death and could be predicted with several perioperative variables, including preoperative intra-aortic balloon pump use, urgent surgery, and prolonged cardiopulmonary bypass. In particular, 3 potentially modifiable variables were also independently and strongly associated with AKI. These were preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration. CONCLUSIONS: AKI after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication.
Authors: Amit X Garg; Neal Badner; Sean M Bagshaw; Meaghan S Cuerden; Dean A Fergusson; Alexander J Gregory; Judith Hall; Gregory M T Hare; Boris Khanykin; Shay McGuinness; Chirag R Parikh; Pavel S Roshanov; Nadine Shehata; Jessica M Sontrop; Summer Syed; George I Tagarakis; Kevin E Thorpe; Subodh Verma; Ron Wald; Richard P Whitlock; C David Mazer Journal: J Am Soc Nephrol Date: 2019-06-20 Impact factor: 10.121
Authors: Julie Ho; Martina Reslerova; Brent Gali; Ang Gao; Jennifer Bestland; David N Rush; Peter W Nickerson; Claudio Rigatto Journal: Clin J Am Soc Nephrol Date: 2011-09-01 Impact factor: 8.237
Authors: Kevin W Lobdell; Devin M Parker; Donald S Likosky; Michael Rezaee; Moritz Wyler von Ballmoos; Shama S Alam; Sherry Owens; Heather Thiessen-Philbrook; Todd MacKenzie; Jeremiah R Brown Journal: J Thorac Cardiovasc Surg Date: 2018-04-11 Impact factor: 5.209