D Hori1, N M Katz1, D M Fine2, M Ono3, V M Barodka4, L C Lester4, G Yenokyan5, C W Hogue6,7. 1. Division of Cardiac Surgery, Department of Surgery. 2. Division of Nephrology, Department of Medicine. 3. Texas Heart Institute, Houston, TX, USA. 4. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Biostatistics Consulting Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. 6. Division of Cardiac Surgery, Department of Surgery choguetwo@gmail.com. 7. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND: While urine flow rate ≤0.5 ml kg-1 h-1 is believed to define oliguria during cardiopulmonary bypass (CPB), it is unclear whether this definition identifies risk for acute kidney injury (AKI) . The purpose of this retrospective study was to evaluate if urine flow rate during CPB is associated with AKI. METHODS: Urine flow rate was calculated in 503 patients during CPB. AKI in the first 48 h after surgery was defined by the Kidney Disease: Improving Global Outcomes classification. Adjusted risk factors associated with AKI and urine flow rate were assessed. RESULTS: Patients with AKI [n=149 (29.5%)] had lower urine flow rate than those without AKI (P<0.001). The relationship between urine flow and AKI risk was non-linear, with an inflection point at 1.5 ml kg-1 h-1 Among patients with urine flow <1.5 ml kg-1 h-1, every 0.5 ml kg-1 h-1 higher urine flow reduced the adjusted risk of AKI by 26% (95% CI 13-37; P<0.001). Urine flow rate during CPB was independently associated with the risk for AKI. Age up to 80 years and preoperative diuretic use were inversely associated with urine flow rate; mean arterial pressure on CPB (when <87 mmHg) and CPB flow were positively associated with urine flow rate. CONCLUSIONS: Urine flow rate during CPB <1.5 ml kg-1 h-1 identifies patients at risk for cardiac surgery-associated AKI. Careful monitoring of urine flow rate and optimizing mean arterial pressure and CPB flow might be a means to ensure renal perfusion during CPB. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00769691 and NCT00981474.
BACKGROUND: While urine flow rate ≤0.5 ml kg-1 h-1 is believed to define oliguria during cardiopulmonary bypass (CPB), it is unclear whether this definition identifies risk for acute kidney injury (AKI) . The purpose of this retrospective study was to evaluate if urine flow rate during CPB is associated with AKI. METHODS: Urine flow rate was calculated in 503 patients during CPB. AKI in the first 48 h after surgery was defined by the Kidney Disease: Improving Global Outcomes classification. Adjusted risk factors associated with AKI and urine flow rate were assessed. RESULTS:Patients with AKI [n=149 (29.5%)] had lower urine flow rate than those without AKI (P<0.001). The relationship between urine flow and AKI risk was non-linear, with an inflection point at 1.5 ml kg-1 h-1 Among patients with urine flow <1.5 ml kg-1 h-1, every 0.5 ml kg-1 h-1 higher urine flow reduced the adjusted risk of AKI by 26% (95% CI 13-37; P<0.001). Urine flow rate during CPB was independently associated with the risk for AKI. Age up to 80 years and preoperative diuretic use were inversely associated with urine flow rate; mean arterial pressure on CPB (when <87 mmHg) and CPB flow were positively associated with urine flow rate. CONCLUSIONS: Urine flow rate during CPB <1.5 ml kg-1 h-1 identifies patients at risk for cardiac surgery-associated AKI. Careful monitoring of urine flow rate and optimizing mean arterial pressure and CPB flow might be a means to ensure renal perfusion during CPB. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00769691 and NCT00981474.
Authors: Andrew K Roy; Catherine Mc Gorrian; Cecelia Treacy; Edel Kavanaugh; Alice Brennan; Niall G Mahon; Patrick T Murray Journal: Cardiorenal Med Date: 2013-02-26 Impact factor: 2.041
Authors: Colin R Lenihan; Maria E Montez-Rath; Christina T Mora Mangano; Glenn M Chertow; Wolfgang C Winkelmayer Journal: Ann Thorac Surg Date: 2012-12-25 Impact factor: 4.330
Authors: Kenneth Brady; Brijen Joshi; Christian Zweifel; Peter Smielewski; Marek Czosnyka; R Blaine Easley; Charles W Hogue Journal: Stroke Date: 2010-07-22 Impact factor: 7.914
Authors: Masahiro Ono; Kenneth Brady; R Blaine Easley; Charles Brown; Michael Kraut; Rebecca F Gottesman; Charles W Hogue Journal: J Thorac Cardiovasc Surg Date: 2013-09-26 Impact factor: 5.209
Authors: David L S Morales; Minoo N Kavarana; David N Helman; John D Madigan; Matthew R Williams; Donald W Landry; Mehmet C Oz Journal: Crit Care Med Date: 2002-06 Impact factor: 7.598
Authors: Masahiro Ono; George J Arnaoutakis; Derek M Fine; Kenneth Brady; R Blaine Easley; Yueying Zheng; Charles Brown; Nevin M Katz; Morgan E Grams; Charles W Hogue Journal: Crit Care Med Date: 2013-02 Impact factor: 7.598
Authors: Alfred H Stammers; Eric A Tesdahl; Linda B Mongero; Kirti P Patel; Courtney C Petersen; Jennifer Arriola Vucovich; Jeffrey P Jacobs Journal: J Extra Corpor Technol Date: 2021-03
Authors: Aaron J Chang; Yohei Nomura; Viachaslau M Barodka; Daijiro Hori; Jonathan T Magruder; Nevin M Katz; Dan E Berkowitz; Charles W Hogue Journal: Anesth Analg Date: 2017-12 Impact factor: 5.108
Authors: Natalie A Silverton; Isaac E Hall; Natalia P Melendez; Brad Harris; Jackson S Harley; Samuel R Parry; Lars R Lofgren; Gregory J Stoddard; Guillaume L Hoareau; Kai Kuck Journal: J Cardiothorac Vasc Anesth Date: 2021-02-04 Impact factor: 2.894
Authors: Hyung-Chul Lee; Soo Bin Yoon; Seong-Mi Yang; Won Ho Kim; Ho-Geol Ryu; Chul-Woo Jung; Kyung-Suk Suh; Kook Hyun Lee Journal: J Clin Med Date: 2018-11-08 Impact factor: 4.241
Authors: Natalie A Silverton; Lars R Lofgren; Isaac E Hall; Gregory J Stoddard; Natalia P Melendez; Michael Van Tienderen; Spencer Shumway; Bradley J Stringer; Woon-Seok Kang; Carter Lybbert; Kai Kuck Journal: Anesthesiology Date: 2021-09-01 Impact factor: 8.986