Jifu Jin1,2,3,4,5, Jiarui Xu1,2,3,4, Sujuan Xu1,2,3,4, Jiachang Hu1,2,3,4, Wuhua Jiang1,2,3,4, Bo Shen1,2,3,4, Chunsheng Wang6, Jie Teng7,8,9,10, Xiaoqiang Ding11,12,13,14. 1. Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. 2. Shanghai Medical Center of Kidney Disease, Shanghai, China. 3. Shanghai Institute of Kidney and Dialysis, Shanghai, China. 4. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China. 5. Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China. 6. Department of Cardiac Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. 7. Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. teng.jie@zs-hospital.sh.cn. 8. Shanghai Medical Center of Kidney Disease, Shanghai, China. teng.jie@zs-hospital.sh.cn. 9. Shanghai Institute of Kidney and Dialysis, Shanghai, China. teng.jie@zs-hospital.sh.cn. 10. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China. teng.jie@zs-hospital.sh.cn. 11. Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. ding.xiaoqiang@zs-hospital.sh.cn. 12. Shanghai Medical Center of Kidney Disease, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn. 13. Shanghai Institute of Kidney and Dialysis, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn. 14. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China. ding.xiaoqiang@zs-hospital.sh.cn.
Abstract
BACKGROUND: Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery. METHODS: A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 h during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25). RESULTS: The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2 [1.0-4.0] vs 2.1 [1.0-3.0] d, P < 0.001; 3.2 [1.0-4.0] vs 2.3 [1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine. CONCLUSIONS: Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.
BACKGROUND: Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery. METHODS: A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 h during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25). RESULTS: The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2 [1.0-4.0] vs 2.1 [1.0-3.0] d, P < 0.001; 3.2 [1.0-4.0] vs 2.3 [1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine. CONCLUSIONS: Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.
Authors: Herbert P Wiedemann; Arthur P Wheeler; Gordon R Bernard; B Taylor Thompson; Douglas Hayden; Ben deBoisblanc; Alfred F Connors; R Duncan Hite; Andrea L Harabin Journal: N Engl J Med Date: 2006-05-21 Impact factor: 91.245
Authors: Jason A Foland; James D Fortenberry; Barry L Warshaw; Robert Pettignano; Robert K Merritt; Micheal L Heard; Kris Rogers; Chris Reid; April J Tanner; Kirk A Easley Journal: Crit Care Med Date: 2004-08 Impact factor: 7.598
Authors: Andrea Lassnigg; Edith R Schmid; Michael Hiesmayr; Christian Falk; Wilfred Druml; Peter Bauer; Daniel Schmidlin Journal: Crit Care Med Date: 2008-04 Impact factor: 7.598