Bahar I, Akgul A, Ozatik MA, et al: Acute renal failure following open heart surgery: Risk factors and prognosis

Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Perfusion (Impact Factor: 0.94). 11/2005; 20(6):317-22. DOI: 10.1191/0267659105pf829oa
Source: PubMed


Acute renal failure (ARF) development after cardiac surgery carries high mortality and morbidity.
Out of 14437 consecutive patients undergoing open-heart surgery between January 1991 and May 2001, 168 (1.16%) developed postoperative ARF mandating hemodialysis. Possible perioperative risk factors, and the prognosis of this dreadful, often fatal complication were investigated.
The mortality rate in this group was 79.7% (134 patients). The risk factors associated with postoperative ARF were advanced age (p=0.000), diabetes mellitus (p=0.000), hypertension (p=0.000), high preoperative serum creatinine levels (p=0.004), impaired left ventricular function (p= 0.002), urgent operation (p=0.000) or reoperation (p=0.007), prolonged cardiopulmonary bypass (CPB) (p =0.000) and aortic cross-clamp (ACC) (p =0.000) periods, level of hypothermia (p =0.000), concomitant procedures (p =0.000), low cardiac output state (p =0.000), re-exploration for bleeding or pericardial tamponade (p =0.000), and deep sternal or systemic infection (p = 0.000). Of those who could be discharged from hospital, renal functions were restored in 21 patients (12.5%); however, eight patients (4.7%) became hemodialysis dependent. The mean follow-up period was 5.7+/-3.2 years (range: 4 months to 13 years; a total of 195 patient-years), and 10-year survival was 58.6+/-10.2% in the discharged patients.
ARF development after cardiac surgery often results in high morbidity and mortality. Recognizing risk factors permits the timely institution of proper treatment, which is the key to reducing untoward outcomes.

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    • "In addition to hypothermia, vasoconstriction, and exposure to the microemboli generated by the activated cascades, structural and functional changes in the kidney may develop quickly. These changes are initiated as mild cortical or medullar edema and may proceed with the breakdown of tubular cells and result in necrosis, which is manifested as clinical symptoms and abnormal blood urea nitrogen and Cr levels as a consequence of a 30% to 40% decrease in the number of nephrons [16]. Others have also reported that the etiologies of renal impairment related to cardiac surgery on CPB remain unclear and that there have been only a few risk factors reported, such as old age, arterial HTN, underlying DM, impaired left ventricular ejection fraction, underlying amyloidosis, history of previous nephritic attacks, and long-term CPB during cardiac surgery. "
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    ABSTRACT: Background Open heart surgery using cardiopulmonary bypass (CPB) is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) is a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in cardiac surgery (CS). Methods Thirty-seven adult patients undergoing CS with CPB were included in this retrospective study. They had normal preoperative renal function, as assessed by the creatinine (Cr) level, NGAL level, and estimated glomerular filtration rate. Serial evaluation of serum NGAL and Cr levels was performed before, immediately after, and 24 hours after the operation. Patients were divided into two groups: those who showed normal immediate postoperative serum NGAL levels (group A, n=30) and those who showed elevated immediate postoperative serum NGAL levels (group B, n=7). Statistical analysis was performed using Statistical Package for the Social Sciences version 18. Results Of the 37 patients, 6 (6/37, 16.2%) were diagnosed with AKI. One patient belonged to group A (1/30, 3.3%), and 5 patients belonged to group B (5/7, 71.4%). Two patients in group B (2/7, 28.5%) required further renal replacement therapy. Death occurred in only 1 patient (1/37, 2.7%), who belonged to group B. Conclusion The results of this study suggest that postoperative plasma NGAL levels can be used as an early biomarker for the detection of AKI following CS using CPB. Further studies with a larger sample size are needed to confirm our results.
    Korean Journal of Thoracic and Cardiovascular Surgery 06/2014; 47(3):240-8. DOI:10.5090/kjtcs.2014.47.3.240
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    • "It is known that hydration reduces the patient's risk of developing AKI.(8) However, hypotension is an important issue and requires aggressive correction to maintain renal perfusion and thus preserve its function.(9) "
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    ABSTRACT: Acute kidney injury is a common complication after cardiac surgery and is associated with increased morbidity and mortality and increased length of stay in the intensive care unit. Considering the high prevalence of acute kidney injury and its association with worsened prognosis, the development of strategies for renal protection in hospitals is essential to reduce the associated high morbidity and mortality, especially for patients at high risk of developing acute kidney injury, such as patients who undergo cardiac surgery. This integrative review sought to assess the evidence available in the literature regarding the most effective interventions for the prevention of acute kidney injury in patients undergoing cardiac surgery. To select the articles, we used the CINAHL and MedLine databases. The sample of this review consisted of 16 articles. After analyzing the articles included in the review, the results of the studies showed that only hydration with saline has noteworthy results in the prevention of acute kidney injury. The other strategies are controversial and require further research to prove their effectiveness.
    Revista Brasileira de Terapia Intensiva 04/2014; 26(2):183-192. DOI:10.5935/0103-507X.20140027
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    • "It is commonly purported that poor perioperative hemodynamic control during cardiac surgery leads to postoperative acute kidney injury (AKI) [1] [2] [3] [4] [5] [6] [7] [8] [9]. Systolic blood pressure and pulse pressure amplification are due to changes in arterial stiffness that affect wave propagation along the arterial tree. "
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    ABSTRACT: Background. Postoperative acute kidney injury (AKI) is associated with high mortality and substantial cost after aortocoronary bypass graft (CABG) surgery. We tested the hypothesis that intraoperative systolic blood pressure variation is associated with postoperative AKI. Methods. We gathered demographic, procedural, blood pressure, and renal outcome data for 7,247 CABG surgeries at a single institution between 1996 and 2005. A development/validation cohort methodology was randomly divided (66% and 33%, resp.). Peak postoperative serum creatinine rise relative to baseline (%ΔCr) was the primary AKI outcome variable. Markers reflective of intraoperative systolic blood pressure variation were derived for each patient including (1) peak and nadir values (absolute and relative to baseline) and (2) excursion episodes beyond selected thresholds (by duration, frequency, and duration × degree). Each marker of systolic blood pressure variation was then separately evaluated for association with AKI using linear regression models with adjustment for several known risk factors (age, aprotinin use, congestive heart failure, previous myocardial infarction, baseline creatinine, bypass time, diabetes, weight, concomitant valve surgery, gender, and preoperative pulse pressure). Results. An association was identified between systolic blood pressure relative to baseline and postoperative AKI (P < 0.006). Conclusions. In CABG surgery patients, intraoperative systolic blood pressure decrease relative to baseline systolic blood pressure is independently associated with postoperative AKI.
    Anesthesiology Research and Practice 11/2013; 2013:174091. DOI:10.1155/2013/174091
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