1
|
Milne B, Gilbey T, De Somer F, Kunst G. Adverse renal effects associated with cardiopulmonary bypass. Perfusion 2024; 39:452-468. [PMID: 36794518 PMCID: PMC10943608 DOI: 10.1177/02676591231157055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Cardiac surgery on cardiopulmonary bypass (CPB) is associated with postoperative renal dysfunction, one of the most common complications of this surgical cohort. Acute kidney injury (AKI) is associated with increased short-term morbidity and mortality and has been the focus of much research. There is increasing recognition of the role of AKI as the key pathophysiological state leading to the disease entities acute and chronic kidney disease (AKD and CKD). In this narrative review, we will consider the epidemiology of renal dysfunction after cardiac surgery on CPB and the clinical manifestations across the spectrum of disease. We will discuss the transition between different states of injury and dysfunction, and, importantly, the relevance to clinicians. The specific facets of kidney injury on extracorporeal circulation will be described and the current evidence evaluated for the use of perfusion-based techniques to reduce the incidence and mitigate the complications of renal dysfunction after cardiac surgery.
Collapse
Affiliation(s)
- Benjamin Milne
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Tom Gilbey
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - Filip De Somer
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Gudrun Kunst
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London British Heart Foundation Centre of Excellence, London, UK
| |
Collapse
|
2
|
Xiong L, Yu F, Ge W, Xu H. Acute kidney injury interacts with VKORC1 genotype on initiative warfarin dose among heart surgery recipients: a real-world research. Sci Rep 2023; 13:21750. [PMID: 38066032 PMCID: PMC10709552 DOI: 10.1038/s41598-023-46895-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Patients who receive heart valve surgery need anticoagulation prophylaxis to reduce the risk of thrombosis. Warfarin often is a choice but its dosage varies due to gene and clinical factors. We aim to study, among them, if there is an interaction between acute kidney injury and two gene polymorphisms from this study. We extracted data of heart valve surgery recipients from the electronic health record (EHR) system of a medical center. The primary outcome is about the average daily dose of warfarin, measured as an additive interaction effect (INTadd) between acute kidney injury (AKI) and warfarin-related gene polymorphisms. The confounders, including age, sex, body surface area (BSA), comorbidities (i.e., atrial fibrillation [AF], hypertension [HTN], congestive heart failure [CHF]), serum albumin level, warfarin-relevant gene polymorphism (i.e., CYP2C9, VKORC1), prosthetic valve type (i.e., metal, bio), and warfarin history were controlled via a multivariate-linear regression model. The study included 200 patients, among whom 108 (54.00%) are female. Further, the mean age is 54.45 years, 31 (15.50%) have CHF, and 40 (20.00%) patients were prescribed concomitant amiodarone, which potentially overlays with the warfarin prophylaxis period. During the follow-up, AKI occurred in 30 (15.00%) patients. VKORC1 mutation (1639G>A) occurred in 25 (12.50%) patients and CYPC29 *2 or *3 mutations presented in 20 patients (10.00%). We found a significant additive interaction effect between AKI and VKORC1 (- 1.17, 95% CI - 1.82 to - 0.53, p = 0.0004). This result suggests it is probable that there is an interaction between acute kidney injury and the VKORC1 polymorphism for the warfarin dose during the initial period of anticoagulation prophylaxis.
Collapse
Affiliation(s)
- Liang Xiong
- Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Feng Yu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Weihong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hang Xu
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
- School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China.
| |
Collapse
|
3
|
Puzanov A, Tkachuk V, Maksymenko A. Acute kidney injury after arterial switch operation: incidence, risk factors, clinical impact - a retrospective single-center study. Ren Fail 2023; 45:2167661. [PMID: 36692196 PMCID: PMC9879166 DOI: 10.1080/0886022x.2023.2167661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This retrospective study aimed to determine the incidence, risk factors, and outcomes of acute kidney injury (AKI) in neonates following the arterial switch operation (ASO) for transposition of great arteries (TGA). METHODS Retrospective review of medical data of children who underwent ASO in 2019-2020 in the Ukrainian Children's Cardiac Center. RESULTS 76 consecutive neonatal patients were included, 48 developed AKI after ASO (51.7%), and 24 - had severe AKI (25.8%). Severe AKI development was associated with longer cross-clamp time: 82 (61-127) versus 73.5 (53-136) in the non-severe AKI group (p = 0.02). 76 min of cross-clamp time were defined as a threshold value for increased severe AKI risk, OR 4.4 (95% CI: 1.5 - 13, p = 0.01). Higher lactate levels during cardiopulmonary bypass (CPB) increased severe AKI development risk, OR 1.5 (95% CI: 1.0 - 2.0, p = 0.03). Children with severe AKI had prolonged mechanical ventilation, longer time to negative fluid balance, and higher postoperative day 3 (POD3) Inotropic Score (IS). Only one patient required peritoneal dialysis. CONCLUSIONS In our study, 51.7% of patients developed AKI after ASO, 25.8%-severe AKI. Prolonged cross-clamp time and higher lactate levels during cardiopulmonary bypass increased the risk for severe AKI development. The development of AKI was associated with prolonged mechanical ventilation, longer time to negative fluid balance, higher POD 3 Inotropic Score.
Collapse
Affiliation(s)
- Anton Puzanov
- Ukrainian Children’s Cardiac Center, Kyiv, Ukraine,CONTACT Anton Puzanov Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
| | | | | |
Collapse
|
4
|
Rasmussen SB, Boyko Y, Ranucci M, de Somer F, Ravn HB. Cardiac surgery-Associated acute kidney injury - A narrative review. Perfusion 2023:2676591231211503. [PMID: 37905794 DOI: 10.1177/02676591231211503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) is a serious complication seen in approximately 20-30% of cardiac surgery patients. The underlying pathophysiology is complex, often involving both patient- and procedure related risk factors. In contrast to AKI occurring after other types of major surgery, the use of cardiopulmonary bypass comprises both additional advantages and challenges, including non-pulsatile flow, targeted blood flow and pressure as well as the ability to manipulate central venous pressure (congestion). With an increasing focus on the impact of CSA-AKI on both short and long-term mortality, early identification and management of high-risk patients for CSA-AKI has evolved. The present narrative review gives an up-to-date summary on definition, diagnosis, underlying pathophysiology, monitoring and implications of CSA-AKI, including potential preventive interventions. The review will provide the reader with an in-depth understanding of how to identify, support and provide a more personalized and tailored perioperative management to avoid development of CSA-AKI.
Collapse
Affiliation(s)
- Sebastian Buhl Rasmussen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yuliya Boyko
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesiology and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Hanne Berg Ravn
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Rafiq Abbasi MS, Sultan K, Manzoor R, Nizami AA, Ullah N, Mushtaq A, Saleem H, Umaira Khan Q, Akbar A, Khan Jadoon S, Tasneem S, Saleem Khan M, Alvi S. Assessment of renal function and prevalence of acute kidney injury following coronary artery bypass graft surgery and associated risk factors: A retrospective cohort study at a tertiary care hospital in Islamabad, Pakistan. Medicine (Baltimore) 2023; 102:e35482. [PMID: 37861475 PMCID: PMC10589541 DOI: 10.1097/md.0000000000035482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
Acute kidney injury (AKI) is a sudden decline in renal function after cardiac surgery. It is characterized by a significant reduction in glomerular filtration rate, alterations in serum creatinine (S.Cr) levels, and urine output. This study aimed to retrospectively analyze a cohort of 704 patients selected using stringent inclusion and exclusion criteria. AKI was defined by an increase of 0.3 mg/dL in S.Cr levels compared to baseline. Data were collected from the hospital and analyzed using SPSS 16.0. Data analysis revealed that 22% (n = 155) of the patients developed AKI on the second post-operative day, accompanied by a substantial increase in S.Cr levels (from 1.064 ± 0.2504 to 1.255 ± 0.2673, P < .000). Age and cardiopulmonary bypass duration were identified as risk factors along with ejection fraction and days of hospital stay, contributing to the development of AKI. Early renal replacement therapy can be planned when the diagnosis of AKI is established early after surgery.
Collapse
Affiliation(s)
| | - Khawar Sultan
- Rawal Institute of Health Sciences, Islamabad, Pakistan
| | - Rukhsana Manzoor
- IMT-2, East Kent University Hospital, Canterbury, United Kingdom
| | - Awais Ahmad Nizami
- Director Cath Lab, Department of Cardiology, Shahida Islam Institute of Cardiology, Bahawalpur, Pakistan
| | - Naeem Ullah
- Post Graduate Resident Nephrology, Pakistan Institute of Medical Sciences, PIMS, Islamabad, Pakistan
| | - Adnan Mushtaq
- Registrar Nephrology, Pakistan institute of Medical Sciences (PIMS) Islamabad, Islamabad, Pakistan
| | | | | | - Amna Akbar
- District Headquarter Hospital Jhelum Valley, Muzaffarabad AJK, Pakistan
| | | | - Sabahat Tasneem
- Public Health Professional, Health Services Academy, Islamabad, Pakistan
| | | | - Sarosh Alvi
- Teaching Faculty, University of Khartoum, Khartoum, Sudan
| |
Collapse
|
6
|
Peng W, Yang B, Qiao H, Liu Y, Lin Y. Prediction of acute kidney injury following coronary artery bypass graft surgery in elderly Chinese population. J Cardiothorac Surg 2023; 18:287. [PMID: 37817194 PMCID: PMC10566186 DOI: 10.1186/s13019-023-02372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common and serious complication following coronary artery bypass graft (CABG) surgery. Advanced age is an independent risk factor for the development of AKI, and the incidence of AKI in the elderly increases more rapidly than that in younger patients. This study aimed to develop and validate the risk prediction model for AKI after CABG in elderly patients. METHODS Patients were retrospectively recruited from January 2019 to December 2020. AKI after CABG was defined according to the criteria of Kidney Disease Improving Global Outcomes (KDIGO). The entire population was divided into the derivation set and the verification set using random split sampling (ratio: 7:3). Lasso regression method was applied to screen for the variables in the derivation set. Decision curve analysis (DCA) and receiver operating characteristic (ROC) curves were plotted to analyze the predictive ability of the model for AKI risk in the derivation set and the verification set. RESULTS A total of 2155 patients were enrolled in this study. They were randomly divided into the derivation set (1509 cases) and the validation set (646 cases). Risk factors associated with AKI were selected by Lasso regression including T2DM, diabetes mellitus type intraoperative use of intra-aortic ballon pump (IABP), cardiopulmonary bypass (CPB), epinephrine, isoprenaline, and so on. The model was established by Lasso logistic regression. The area under the ROC curve (AUC) of the model for the derivation set was 0.754 (95% CI: 0.720 - 0.789), and that for the validation cohort was 0.718 (95% CI: 0.665 - 0.771). CONCLUSION In this study, the model with significant preoperative and intraoperative variables showed good prediction performance for AKI following CABG in elderly patients to optimize postoperative treatment strategies and improve early prognosis.
Collapse
Affiliation(s)
- Wenxing Peng
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Bo Yang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huanyu Qiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongmin Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Huang X, Lu X, Guo C, Lin S, Zhang Y, Zhang X, Cheng E, Liu J. Effect of preoperative risk on the association between intraoperative hypotension and postoperative acute kidney injury in cardiac surgery. Anaesth Crit Care Pain Med 2023; 42:101233. [PMID: 37061091 DOI: 10.1016/j.accpm.2023.101233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/25/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Acute kidney injury (AKI), a common and severe complication after cardiac surgery, has been demonstrated to be associated with intraoperative hypotension (IOH). The reproducibility of this finding and whether preoperative risk modifies the association remain unclear. We hypothesised that the relationship between IOH and AKI after cardiac surgery varies by preoperative risk. METHODS We conducted a single-centre, retrospective cohort study to analyse the association between IOH and postoperative AKI by stratifying patients using preoperative risk factors. IOH was defined as a mean arterial pressure (MAP) of less than 65 mmHg and characterised by the cumulative duration and area under the curve (AUC). RESULTS Ten variables could be identified as risk factors: age, smoking status, NYHA III/Ⅳ, emergency surgery, peripheral vascular disease, cerebrovascular disease, heart failure, hypertension, previous cardiac surgery, and NT-proBNP concentration. The risk prediction model divided the patients into three equal-sized preoperative risk groups. Low-risk patients demonstrated no association between AKI and IOH of any severity, while high-risk patients demonstrated a statistically significant association between AKI and IOH with a cumulative duration greater than 104 min (adjusted odds ratio [OR]: 2.27, 95% confidence interval [CI]: 1.10-4.74; and adjusted OR: 3.63, 95% CI: 1.77-7.58) and an AUC greater than 905 mmHg min (adjusted OR: 2.08, 95% CI: 1.01-4.36; and adjusted OR: 4.00, 95% CI: 1.95-8.43). CONCLUSION IOH is a significant independent risk factor for AKI after cardiac surgery. Patients with higher baseline risk showed a more prominent relationship between IOH and postoperative AKI than low-risk patients.
Collapse
Affiliation(s)
- Xiaofan Huang
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Xian Lu
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Chunyan Guo
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Shuchi Lin
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Ying Zhang
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Xiaohan Zhang
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Erhong Cheng
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Jindong Liu
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, China; Jiangsu Province Key Laboratory of Anaesthesiology, Xuzhou Medical University, China; Jiangsu Province Key Laboratory of Anaesthesia and Analgesia Application Technology, Xuzhou Medical University, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, China.
| |
Collapse
|
8
|
Maia J, Rodrigues AF, Dias AL, Azevedo B, Leite-Moreira A, Lourenço A, Almeida C. Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction. ACTA MEDICA PORT 2023; 36:567-587. [PMID: 36889336 DOI: 10.20344/amp.18755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/06/2022] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Cardiac surgery may induce acute kidney injury and the need for renal replacement therapy. It is also associated with higher hospital costs, morbidity and mortality. The aims of this study were to investigate predictors of cardiac surgery associated acute kidney injury in our population and to determine the burden of acute kidney injury in elective cardiac surgery, evaluating the potential cost effectiveness of preventing it through the application of the Kidney Disease: Improving Global Outcomes bundle of care to high-risk patient groups identified by the [TIMP-2]x[IGFBP7] used as a screening test. MATERIAL AND METHODS In a University Hospital single-center retrospective cohort study we analyzed a consecutive sample of adults who underwent elective cardiac surgery between January and March 2015. A total of 276 patients were admitted during the study period. Data from all patients was analyzed until hospital discharge or the patient's death. The economic analysis was performed from the hospital costs' perspective. RESULTS Cardiac surgery associated acute kidney injury occurred in 86 patients (31%). After adjustment, higher preoperative serum creatinine (mg/L, ORadj = 1.09; 95% CI: 1.01 - 1.17), lower preoperative hemoglobin (g/dL, ORadj = 0.79; 95% CI: 0.67 - 0.94), chronic systemic hypertension (ORadj = 5.00; 95% CI: 1.67 - 15.02), an increase in cardiopulmonary bypass time (min, ORadj = 1.01; 95% CI: 1.00 - 1.01) and perioperative use of sodium nitroprusside (ORadj = 6.33; 95% CI: 1.80 - 22.28) remained significantly associated with cardiac surgery related acute kidney injury. The expected cumulative surplus cost for the hospital linked with cardiac surgery associated acute kidney injury (86 patients) was €120 695.84. Based on a median absolute risk reduction of 16.6%, by dosing kidney damage biomarkers in every patient and using preventive measures in high-risk patients, we would expect a break-even point upon screening 78 patients, which would translate, in our patient cohort, into an overall cost benefit of €7145. CONCLUSION Preoperative hemoglobin, serum creatinine, systemic hypertension, cardiopulmonary bypass time and perioperative use of sodium nitroprusside were independent predictors of cardiac surgery associated acute kidney injury. Our cost-effectiveness modelling suggests that the use of kidney structural damage biomarkers combined with an early prevention strategy could be associated with potential cost savings.
Collapse
Affiliation(s)
- João Maia
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | | | - Ana Lídia Dias
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto; Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Bárbara Azevedo
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - André Leite-Moreira
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto; Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - André Lourenço
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto; Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Cláudia Almeida
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| |
Collapse
|
9
|
Griffin BR, Vaughan-Sarrazin M, Perencevich E, Yamada M, Swee M, Sambharia M, Girotra S, Reisinger HS, Jalal D. Risk Factors for Death Among Veterans Following Acute Kidney Injury. Am J Med 2023; 136:449-457. [PMID: 36708794 PMCID: PMC10765959 DOI: 10.1016/j.amjmed.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/08/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Acute kidney injury is prevalent among hospitalized veterans, and associated with increased risk of death following discharge. However, risk factors for death following acute kidney injury have not been well defined. We developed a mortality prediction model using Veterans Health Administration data. METHODS This retrospective cohort study included inpatients from 2013 through 2018 with a creatinine increase of ≥0.3 mg/dL. We evaluated 45 variables for inclusion in our final model, with a primary outcome of 1-year mortality. Bootstrap sampling with replacement was used to identify variables selected in >60% of models using stepwise selection. Best sub-sets regression using Akaike information criteria was used to identify the best-fitting parsimonious model. RESULTS A total of 182,683 patients were included, and 38,940 (21.3%) died within 1 year of discharge. The 10-variable model to predict mortality included age, chronic lung disease, cancer within 5 years, unexplained weight loss, dementia, congestive heart failure, hematocrit, blood urea nitrogen, bilirubin, and albumin. Notably, acute kidney injury stage, chronic kidney disease, discharge creatinine, and proteinuria were not selected for inclusion. C-statistics in the primary validation cohorts were 0.77 for the final parsimonious model, compared with 0.52 for acute kidney injury stage alone. CONCLUSION We identified risk factors for long-term mortality following acute kidney injury. Our 10-variable model did not include traditional renal variables, suggesting that non-kidney factors contribute to the risk of death more than measures of kidney disease in this population, a finding that may have implications for post-acute kidney injury care.
Collapse
Affiliation(s)
- Benjamin R Griffin
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City.
| | - Mary Vaughan-Sarrazin
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Eli Perencevich
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Masaaki Yamada
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Melissa Swee
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Meenakshi Sambharia
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Saket Girotra
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Heather S Reisinger
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Diana Jalal
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| |
Collapse
|
10
|
Mazer CD, Siadati-Fini N, Boehm J, Wirth F, Myjavec A, Brown CD, Koyner JL, Boening A, Engelman DT, Larsson TE, Renfurm R, de Varennes B, Noiseux N, Thielmann M, Lamy A, Laflamme M, von Groote T, Ronco C, Zarbock A. Study protocol of a phase 2, randomised, placebo-controlled, double-blind, adaptive, parallel group clinical study to evaluate the efficacy and safety of recombinant alpha-1-microglobulin in subjects at high risk for acute kidney injury following open-chest cardiac surgery (AKITA trial). BMJ Open 2023; 13:e068363. [PMID: 37024249 PMCID: PMC10410810 DOI: 10.1136/bmjopen-2022-068363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/06/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a common complication after cardiac surgery (CS) and is associated with adverse short-term and long-term outcomes. Alpha-1-microglobulin (A1M) is a circulating glycoprotein with antioxidant, heme binding and mitochondrial-protective mechanisms. RMC-035 is a modified, more soluble, variant of A1M and has been proposed as a novel targeted therapeutic protein to prevent CS-associated AKI (CS-AKI). RMC-035 was considered safe and generally well tolerated when evaluated in four clinical phase 1 studies. METHODS AND ANALYSIS This is a phase 2, randomised, double-blind, adaptive design, parallel group clinical study that evaluates RMC-035 compared with placebo in approximately 268 cardiac surgical patients at high risk for CS-AKI. RMC-035 is administered as an intravenous infusion. In total, five doses will be given. Dosing is based on presurgery estimated glomerular filtration rate (eGFR), and will be either 1.3 or 0.65 mg/kg.The primary study objective is to evaluate whether RMC-035 reduces the incidence of postoperative AKI, and key secondary objectives are to evaluate whether RMC-035 improves postoperative renal function compared with placebo. A blinded interim analysis with potential sample size reassessment is planned once 134 randomised subjects have completed dosing. An independent data monitoring committee will evaluate safety and efficacy data at prespecified intervals throughout the trial. The study is a global multicentre study at approximately 30 sites. ETHICS AND DISSEMINATION The trial was approved by the joint ethics committee of the physician chamber Westfalen-Lippe and the University of Münster (code '2021-778 f-A') and subsequently approved by the responsible ethics committees/relevant institutional review boards for the participating sites. The study is conducted in accordance with Good Clinical Practice, the Declaration of Helsinki and other applicable regulations. Results of this study will be published in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER NCT05126303.
Collapse
Affiliation(s)
- C David Mazer
- Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Physiology and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | - Johannes Boehm
- Department of Cardiovascular Surgery, Technische Universität München, Munchen, Germany
- Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Munchen, Germany
| | - Felix Wirth
- Department of Cardiovascular Surgery, Technische Universität München, Munchen, Germany
- Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Munchen, Germany
| | - Andrej Myjavec
- Department of Cardiac Surgery, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Craig D Brown
- Department of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Jay L Koyner
- Department of Medicine, Section of Nephrology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Andreas Boening
- Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen, Germany
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Medical Center, Springfield, Massachusetts, USA
| | | | - Ronny Renfurm
- Global Drug Development Unit Cardio-Renal-Metabolism, Novartis Pharma AG, Basel, Switzerland
| | - Benoit de Varennes
- Division of Cardiac Surgery, McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Nicolas Noiseux
- Division of Cardiac Surgery, Universite de Montreal, Montreal, Québec, Canada
| | - Matthias Thielmann
- Department for Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Andre Lamy
- Department for Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Maxime Laflamme
- Institut universitaire de cardiologie et de pneumologie de Québec, University of Quebec, Quebec, Quebec, Canada
| | - Thilo von Groote
- Department of Anesthesiology, Intensive Care Medicine, University Hospital Münster, Munster, Germany
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, San Bortolo Hospital of Vicenza, Vicenza, Italy
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care Medicine, University Hospital Münster, Munster, Germany
| |
Collapse
|
11
|
Mo Z, Hu P, Xie Z, Wu Y, Li Z, Fu L, Chen Y, Liang X, Liang H, Dong W. The value of the ACEF II score in Chinese patients with elective and non-elective cardiac surgery. BMC Cardiovasc Disord 2022; 22:513. [PMID: 36457097 PMCID: PMC9716978 DOI: 10.1186/s12872-022-02946-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To evaluate the value of the ACEF II score in predicting postoperative hospital death and acute kidney injury requiring dialysis (AKI-D) in Chinese patients. METHODS This retrospective study included adult patients who underwent cardiopulmonary bypass open heart surgery between January 2010 and December 2015 at Guangdong Provincial People's Hospital. ACEF II was evaluated to predict in-hospital death and AKI-D using the Hosmer-Lemeshow goodness of fit test for calibration and area under the receiver operating characteristic (ROC) curve for discrimination in non-elective and elective cardiac surgery. RESULTS A total of 9748 patients were included. Among them, 1080 underwent non-elective surgery, and 8615 underwent elective surgery. Mortality was 1.8% (177/9748). In elective surgery, the area under the ROC (AUC) of the ACEF II score was 0.704 (95% CI: 0.648-0.759), similar to the ACEF score of 0.709 (95% CI: 0.654-0.763). In non-elective surgery, the AUC of the ACEF II score was 0.725 (95% CI: 0.663-0.787), higher than the ACEF score (AUC = 0.625, 95% CI: 0.553-0.697). The incidence of AKI-D was 3.5% (345/9748). The AUC of the ACEF II score was 0.718 (95% CI: 0.687-0.749), higher than the ACEF score (AUC = 0.626, 95% CI: 0.594-0.658). CONCLUSION ACEF and ACEF II have poor discrimination ability in predicting AKI-D in non-elective surgery. The ACEF II and ACEF scores have the same ability to predict in-hospital death in elective cardiac surgery, and the ACEF II score is better in non-elective surgery. The ACEF II score can be used to assess the risk of AKI-D in elective surgery in Chinese adults.
Collapse
Affiliation(s)
- Zhiming Mo
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Penghua Hu
- Division of Nephrology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, China
| | - Zhiyong Xie
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanhua Wu
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhilian Li
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lei Fu
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanhan Chen
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinling Liang
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huaban Liang
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Dong
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
12
|
Balakhnin DG, Chermnykh II, Ivkin AA, Borisenko DV, Grigoryev EV. The Issue of Acute Kidney Injury in Patients after Cardiac Surgery. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2022. [DOI: 10.21292/2078-5658-2022-19-5-93-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac surgery associated acute kidney injury (CSA-AKI) is a common complication of cardiac surgery resulting from the patient's exposure to a complex combination of factors in the perioperative period. Current diagnostic criteria for AKI may underestimate the incidence of this complication due to certain specific features of cardiac surgery patients. The introduction of new diagnostic biomarkers of kidney injury into clinical practice has shown the prospective of identifying patients in the early stages of CSA-AKI development. Accurate and timely identification of patients at high risk of developing CSA-AKI can also allow performing comprehensive interventions to prevent it. When diagnosed, CSA-AKI management limited to symptomatic treatment.
Collapse
|
13
|
Guo J, Hu Y, Cao S, Feng C, Huang X, Zhou Q. Predictive Value of the Transthoracic Echocardiography Index for Acute Kidney Injury after Cardiac Valve Surgery. J Cardiovasc Dev Dis 2022; 9:jcdd9100316. [PMID: 36286268 PMCID: PMC9604519 DOI: 10.3390/jcdd9100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: We aimed to demonstrate whether the preoperative transthoracic echocardiography index (TTEI) could improve the predictive value of clinical parameters for cardiac valve surgery-associated acute kidney injury (CVS−AKI). Methods: A total of 213 patients who underwent surgical CVS at Renmin Hospital of Wuhan University were consecutively recruited in this retrospective study. TTE assessments were performed within 7 days before surgery and logistic regression was used to determine TTEI. A nomogram was constructed by integrating TTEI and clinical features, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to evaluate the improvement in TTEI for CVS−AKI. Results: Among them, 66 patients (30.9%) developed CVS−AKI. The TTEI was calculated as follows: −6.579 + 0.068 × pulmonary artery systolic pressure (mmHg) −0.742 × LVEF (>55%, yes or no) + 0.346 × left ventricle posterior wall thickness (mm). The nomogram based on the TEEI and other clinical factors possessed excellent performance (C-index = 0.880), had great calibration and discrimination, and was clinically useful. Furthermore, NRI (0.07, 95% confidence interval, 95%CI, 0.01−0.12, p = 0.02) and IDI (0.08, 95%CI, 0.01−0.20, p = 0.02) indicated that TTEI could significantly improve the predictive value of clinical features for CVS−AKI. Conclusions: As a simple access and cost-effective parameter, the preoperative TTEI may be a reliable and useful factor for CVS−AKI.
Collapse
Affiliation(s)
| | | | | | | | | | - Qing Zhou
- Correspondence: ; Tel.: +86-027-8804-1911
| |
Collapse
|
14
|
Risk Factors for Postoperative Acute Kidney Injury in Patients Undergoing Redo Cardiac Surgery Using Cardiopulmonary Bypass. J Cardiovasc Dev Dis 2022; 9:jcdd9080244. [PMID: 36005408 PMCID: PMC9409715 DOI: 10.3390/jcdd9080244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: This paper aimed to investigate the incidence and risk factors of postoperative acute kidney injury (AKI) in adult patients undergoing redo cardiac surgery with cardiopulmonary bypass (CPB), and explore the impact of AKI on early outcomes. Methods: A total of 116 patients undergoing redo cardiac surgery with CPB between November 2017 and May 2021 were included. Patients were divided into two groups, AKI group and non-AKI group, according to the Kidney Disease Improving Global Outcomes criteria. Perioperative variables were retrospectively collected and analyzed. Risk factors for the development of AKI were investigated by univariate and multiple logistic regression models. Clinical outcomes were also compared between the groups. Results: Postoperative AKI occurred in 63 patients (54.3%), among whom renal replacement therapy was required in 12 patients (19.0%). The mechanical ventilation time (AKI: 43.00 (19.00, 72.00) hours; non-AKI: 18.00 (15.00, 20.00) hours; p < 0.001), ICU length of stay (AKI: 4.00 (2.00, 6.00) days; non-AKI: 3.00 (2.00, 4.00) days; p = 0.010), hospital length of stay since operation (AKI: 12.00 (8.00, 18.00) days; non-AKI: 9.00 (7.00, 12.50) days; p = 0.024), dialysis (AKI: 12.00 (19.05%); non-AKI: 0 (0%); p = 0.001), reintubation (AKI: 7.00 (11.11%); non-AKI: 0 (0%); p = 0.035), and hospital mortality (AKI: 8.00 (12.70%); non-AKI: 0 (0%); p = 0.020) were all higher in the AKI group than in the non-AKI group. Multivariate analysis revealed that high aspartate aminotransferase (OR, 1.028, 95% CI, 1.003 to 1.053, p = 0.025), coronary angiogram within 2 weeks before surgery (OR, 3.209, 95% CI, 1.307 to 7.878, p = 0.011) and CPB time (OR, 1.012, 95% CI, 1.005 to 1.019, p = 0.001) were independent risk factors for postoperative AKI. Conclusions: High aspartate aminotransferase, coronary angiogram within 2 weeks before surgery and CPB time seem to be associated with an increased incidence of postoperative AKI in patients with redo cardiac surgery.
Collapse
|
15
|
Al-Githmi IS, Abdulqader AA, Alotaibi A, Aldughather BA, Alsulami OA, Wali SM, Alghamdi MS, Althabaiti TS, Melebary TB. Acute Kidney Injury After Open Heart Surgery. Cureus 2022; 14:e25899. [PMID: 35844317 PMCID: PMC9278797 DOI: 10.7759/cureus.25899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Acute kidney injury (AKI) is a term used to describe when the kidney loses its function rapidly. And it’s associated with an increase in the level of serum creatinine by 0.5 to 1mg/dL. It can be diagnosed by a plethora of criteria such as the Kidney Disease Improving Global Outcomes (KDIGO) and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Cardiac surgery-associated AKI (CSA-AKI) is the most prevalent complication in patients following cardiac surgery and is also linked to increased mortality and morbidity rates. In addition, exogenous and endogenous toxins, ischemia and reperfusion, inflammation, oxidative stress, metabolic factors, and neurohormonal activation may all play a role in the development of CSA-AKI. All these factors may be active at varying time intervals and with different degrees of intensity, or may function simultaneously. Methods: In late 2019, a retrospective study was conducted by reviewing the health data of patients who underwent coronary artery bypass graft (CABG), valvular repairs, and other open cardiac surgeries at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between November 2014 and June 2019. Information was obtained from the Hospital information system, Jeddah, Saudi Arabia. Of the 159 patients who underwent open-heart surgery at KAUH, 126 (79.2%) were male and 33 (20.8%) were female. Patients below 15 years of age and those with poor renal function prior to open cardiac surgery were excluded. The KDIGO criteria were used to diagnose AKI for our patients. Results: In this study, 34% of the patients experienced AKI after open cardiac surgery, and the most frequent risk factor encountered was diabetes mellitus (DM), which was present in 97 (61%) patients, followed by angina pectoris in 93 (58.5%) patients. Hypertension was identified in 85 (53.5%) and acute myocardial infarction in 82 (51.6%) patients. There were only two (1.3%) patients with known cases of chronic obstructive lung disease (COPD). Of the surgeries, 131 (82.4%) were classified as elective and 28 (17.6%) were urgent. Conclusion: The most common risk factor associated with AKI following open-heart surgery is DM, followed by angina pectoris. However, further studies are required to investigate all the cardiac procedures.
Collapse
|
16
|
Digital Holographic Microscopy for Label-Free Detection of Leukocyte Alternations Associated with Perioperative Inflammation after Cardiac Surgery. Cells 2022; 11:cells11040755. [PMID: 35203403 PMCID: PMC8869820 DOI: 10.3390/cells11040755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023] Open
Abstract
In a prospective observational pilot study on patients undergoing elective cardiac surgery with cardiopulmonary bypass, we evaluated label-free quantitative phase imaging (QPI) with digital holographic microscopy (DHM) to describe perioperative inflammation by changes in biophysical cell properties of lymphocytes and monocytes. Blood samples from 25 patients were investigated prior to cardiac surgery and postoperatively at day 1, 3 and 6. Biophysical and morphological cell parameters accessible with DHM, such as cell volume, refractive index, dry mass, and cell shape related form factor, were acquired and compared to common flow cytometric blood cell markers of inflammation and selected routine laboratory parameters. In all examined patients, cardiac surgery induced an acute inflammatory response as indicated by changes in routine laboratory parameters and flow cytometric cell markers. DHM results were associated with routine laboratory and flow cytometric data and correlated with complications in the postoperative course. In a subgroup analysis, patients were classified according to the inflammation related C-reactive protein (CRP) level, treatment with epinephrine and the occurrence of postoperative complications. Patients with regular courses, without epinephrine treatment and with low CRP values showed a postoperative lymphocyte volume increase. In contrast, the group of patients with increased CRP levels indicated an even further enlarged lymphocyte volume, while for the groups of epinephrine treated patients and patients with complicative courses, no postoperative lymphocyte volume changes were detected. In summary, the study demonstrates the capability of DHM to describe biophysical cell parameters of perioperative lymphocytes and monocytes changes in cardiac surgery patients. The pattern of correlations between biophysical DHM data and laboratory parameters, flow cytometric cell markers, and the postoperative course exemplify DHM as a promising diagnostic tool for a characterization of inflammatory processes and course of disease.
Collapse
|
17
|
Guangqing Z, Liwei C, Fei L, Jianshe Z, Guang Z, Yan Z, Jianjun C, Ming T, Hao C, Wei L. Predictive value of neutrophil to lymphocyte ratio on acute kidney injury after on-pump coronary artery bypass: a retrospective, single-center study. Gan To Kagaku Ryoho 2022; 70:624-633. [PMID: 35103920 PMCID: PMC9206599 DOI: 10.1007/s11748-022-01772-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/06/2022] [Indexed: 12/26/2022]
Abstract
Objective To investigate the predictive value of preoperative neutrophil to lymphocyte ratio (NLR) on acute kidney injury (AKI) after on-pump coronary artery bypass (ONCAB). Methods Patients who underwent elective ONCAB for coronary heart disease were included. NLR was calculated according to the results of preoperative routine blood test, patients were divided into non-AKI and AKI groups, and the differences in clinical baseline data between the two groups were compared. Results A total of 154 patients were included in this study, including 57 (37%) with postoperative AKI and 97 (63%) without AKI. Compared with the patients in non-AKI group, those in AKI group had higher NLR (2.63 (1.83, 3.505) vs. 2.06 (1.7, 2.56), p = 0.002), higher serum creatinine (78 (67, 98.5) vs. 70.9 ± 16.8 umol/L, p < 0.001), longer cardiopulmonary bypass time, and longer aortic cross clamp time. After dividing patient into tertiles based on NLR, those with higher NLR had higher risk of postoperative AKI than those with lower NLR (30% vs. 25% vs. 55.8%, p for trend = 0.003). Patients in Tertile2 and Tertile3 had higher NLR compared to those in Tertile1 (p < 0.05); multivariate logistic regression analysis showed patients with elevated preoperative NLR and blood creatinine had higher risk of postoperative AKI. ROC curve showed that patients’ preoperative NLR combined with blood creatinine had better predictive value for postoperative AKI. Conclusion Elevated preoperative NLR is associated with AKI after ONCAB, and had prognostic utility independent of other recognized risk factors. Supplementary Information The online version contains supplementary material available at 10.1007/s11748-022-01772-z.
Collapse
|
18
|
Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury. J Clin Med 2021; 10:jcm10163664. [PMID: 34441960 PMCID: PMC8397056 DOI: 10.3390/jcm10163664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023] Open
Abstract
Acute kidney injury after cardiac surgery is characterized by specific patterns of damage and recovery that are important to consider for management and outcome. The Kidney Disease: Improving Global Outcomes (KDIGO) classification covers only part of the conceptual framework and is thus insufficient for a comprehensive diagnosis. This review highlights the strengths and limitations of the recent criteria and provides an overview of biomarkers of cardiac surgery-associated acute kidney injury (CSA-AKI). The evolving understanding of CSA-AKI as a time-sensitive condition has increased the demand to enhance the diagnostic criteria and translate biomarkers into clinical practice.
Collapse
|
19
|
Provenzano M, Serra R, Michael A, Bolignano D, Coppolino G, Ielapi N, Serraino GF, Mastroroberto P, Locatelli F, De Nicola L, Andreucci M. Smoking habit as a risk amplifier in chronic kidney disease patients. Sci Rep 2021; 11:14778. [PMID: 34285279 PMCID: PMC8292329 DOI: 10.1038/s41598-021-94270-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
Several studies showed the association between non-traditional risk factors [proteinuria and estimated Glomerular Filtration Rate (eGFR)] and cardiovascular (CV) and renal outcomes. Nevertheless, the etiologic role of traditional CV risk factors in referred CKD patients is less defined. Herein, we examined the association between smoking habit and CV events, mortality and CKD progression. We undertook an observational analysis of 1306 stage III–V CKD patients. Smoking habit was modeled as a categorical (never, current or former smokers) and continuous (number of cigarettes/day) variable. Mean eGFR was 35.8 ± 12.5 mL/min/1.73 m2. Never, current and former smokers were 61.1%, 10.8% and 28.1%. During a median follow-up of 2.87 years, current and former smokers were at significant risk for CV events (HRs of 1.93 [95% CI, 1.18–3.16] and 1.44 [95% CI, 1.01–2.05]) versus never smokers. Current smokers were at increased mortality risk (HR 2.13 [95% CI, 1.10–4.11]). Interactions were found between former smokers and proteinuria (p = 0.007) and diabetes (p = 0.041) for renal risk, and between current smokers and male gender (p = 0.044) and CKD stage V (p = 0.039) for renal and mortality risk. In referred CKD patients, smoking habit is independently associated with CV events and mortality. It acts as a risk “amplifier” for the association between other risk factors and renal outcomes.
Collapse
Affiliation(s)
- Michele Provenzano
- Renal Unit, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Viale Europa - Campus "Salvatore Venuta", 88100, Catanzaro, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Ashour Michael
- Renal Unit, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Viale Europa - Campus "Salvatore Venuta", 88100, Catanzaro, Italy
| | - Davide Bolignano
- Renal Unit, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Viale Europa - Campus "Salvatore Venuta", 88100, Catanzaro, Italy
| | - Giuseppe Coppolino
- Renal Unit, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Viale Europa - Campus "Salvatore Venuta", 88100, Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Rome, Italy
| | | | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Francesco Locatelli
- Nephrology Department, Alessandro Manzoni Hospital, Past Director, Lecco, Italy
| | - Luca De Nicola
- Renal Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michele Andreucci
- Renal Unit, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Viale Europa - Campus "Salvatore Venuta", 88100, Catanzaro, Italy.
| |
Collapse
|