Acute renal failure following open heart surgery: Risk factors and prognosis

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DOI: 10.1191/0267659105pf829oa · Source: PubMed
Abstract
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.
Acute renal failure following open heart
surgery: risk factors and prognosis
Ilknur Bahar
1
, Ahmet Akgul
1
, Mehmet Ali Ozatik
1
, Kerem M Vural
1
, Ali E Demirbag
2
, Mediha Boran
3
and Oguz Tasdemir
1
1
Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey;
2
Department of Gastrointestinal Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey;
3
Hemodialysis Unit, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
Background: Acute renal failure (ARF) development
after cardiac surgery carries high mortality and morbid-
ity. Methods: Out of 14 437 consecutive patients under-
going open-heart surgery between January 1991 and May
2001, 168 (1.16%) developed postoperative ARF mandat-
ing hemodialysis. Possible perioperative risk factors, and
the prognosis of this dreadful, often fatal complication
were investigated. Results: The mortality rate in this
group was 79.7% (134 patients). The risk factors asso-
ciated 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) per-
iods, level of hypothermia (p
/0.000), concomitant pro-
cedures (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 5.79
/3.2
years (range: 4 months to 13 years; a total of 195
patient-years), and 10-year survival was 58.69
/10.2% in
the discharged patients. Conclusions: 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. Perfusion (2005)
20, 317
/322.
Introduction
Acute renal failure (ARF) necessitating hemodialy-
sis after cardiac surgery is a rare, but drastic
complication, bearing high mortality and morbidity.
It is characterized by a sudden decrease in the
glomerular filtration rate with consequent fluid
retention and nitrogenous substance increase in
the serum due to the deterioration of renal function.
A variety of underlying causes have been defined,
including low cardiac output, renovascular emboli
or thrombi, acute intrinsic renal failure (so called
‘acute tubular necrosis’) and acute interstitial
nephritis due to use of nephrotoxic agents (amino-
glycosides, diuretics, immunosupressives, etc.).
Each may lead to ARF postoperatively, either in-
dividually or in combination, but, in many cases,
this clinical entity is multifactorial.
1
The reported
incidence could vary between 1 and 30% after open-
heart surgery; however, hemodialysis is needed only
in 1
/3%.
2 4
Prognosis in this group is considerably
poor, both in terms of early results and long-term
follow-up. In many instances, ARF after open-heart
surgery emerges as a component of multi-organ
failure and carries high mortality when further
complicated by ensuing sepsis and low cardiac
output syndrome.
5
This study aimed to detect possible perioperative
risk factors and examine the postoperative course of
this drastic complication in the survivors.
Methods
Between January 1991 and May 2001, 14 437 con-
secutive patients underwent open-heart surgery in
our institution. The procedures were coronary artery
bypass grafting (CABG) in 8614 patients, valve
replacement/repair (VR) in 3906, adult congenital
procedures (ASD, VSD, etc.) in 1228, aortic surgery
in 261, and miscellaneous in 81 patients. There were
concomitant procedures with CABG as well, such as
peripheral arterial surgery (PAS) (141 patients) or
VR (206 patients).
Acute renal failure was diagnosed in the presence
of a sustained low urine output (B
/20 mL/h) and a
Address for correspondence: Ahmet Akgul, MD, Mahmut Esat
Bozkurt Caddesi, No:17/7, Incesu 06600 Ankara, Turkey.
E-mail: aakgul@hotmail.com
Perfusion 2005; 20: 317/322
# 2005 Edward Arnold (Publishers) Ltd 10.1191/0267659105pf829oa
creatinine level doubling base levels after the first 24
postoperative hours despite optimal fluid replace-
ment and diuretic therapy. Severe ARF mandating
hemodialysis was indicated in the presence of
volume overload, persistently high blood potassium
(
/6 meq/L) and blood urea nitrogen (BUN) levels
(
/200 mg/dL), and developed in 168 of these
patients (1.16%; ARF group) in the early postopera-
tive period. This group was compared to those who
did not develop ARF after the operation (control
group). Comparisons by the demographic and peri-
operative data are represented in Tables 1 and 2.
Patients with preoperative chronic renal failure
(either hemodialysis dependent or not), and those
undergoing cardiac procedures without the use of
extracorporeal circulation were excluded from the
study.
Statistical analysis
Statistical analysis was performed using SPSS
(Version 10.0.1, SPSS Inc, Chicago, IL) and numbers
were expressed as mean9
/standard deviation. Uni-
variate analysis was performed by x
2
-test, Fisher’s
exact test or Mann
/Whitney U-test, where applic-
able. A p-value 5
/0.05 was considered statistically
significant.
In multivariate analysis, ARF was accepted as a
dependent variable; age, hypertension, diabetes
mellitus, preoperative serum creatinine and BUN
levels, left ventricular ejection fraction (LVEF),
operative procedures as CABG and concomitant
VR or PAS, proximal aortic surgery, urgent opera-
tions, reoperations, CPB and ACC durations, hy-
pothermia level, re-exploration in the ICU,
postoperative deep sternal or systemic infection,
postoperative inotropic agent or intra-aortic balloon
pump (IABP) support were accepted as independent
risk factors.
Multiple stepwise logistic regression analysis was
used to find out significant perioperative risk
factors, which are believed to have effects on
developing ARF. Relative risks for developing ARF
were calculated in patients who had the highest
ratios in the ARF group. Four variables (postopera-
tive inotropes and IABP counterpulsation support,
re-exploration during ICU stay, deep sternal or
systemic infection), independently or combined,
were considered perioperative relative risk factors.
Each risk factor can be calculated by dividing the
value evaluated in the ARF group by the value
evaluated in the control group (Table 3).
As these four parameters had the highest relative
risks, as shown in Table 3, they were chosen for
evaluated risk analyses. ARF incidence in the
presence of these four parameters was evaluated
(Table 4) as per the following formula:
ARF
positive
ARF
negative
Total
Presence of risk ab a
/b
No risk cdc
/d
Total a
/cb
/da
/b
/c
/d
Incidence/a/a/b
Relative risk
/a(a/b)/c(c/d)
Table 5 shows the statistically significant para-
meters among all the risk factors which was per-
formed by multivariate logistic regression analysis.
Results
Severe ARF mandating hemodialysis in the early
postoperative period (see Materials and methods for
criteria) developed in 168 of the patients (1.16%;
ARF group). The mortality rate for the first 30 days
was 79.7% (134 patients) in this group versus 4.8%
(683 patients) in those who did not develop ARF
Table 1 Demographics
Procedure/variable ARF group ( n
/168) Control group ( n/14 269) p value
Age 56.49
/14.3 (13 /81) 48.69/14.9 (5 /87) 0.000
Sex (male/female) 125/43 10 251/4018 0.464
Hypertension 61 (36%) 2763 (19%) 0.000
Diabetes mellitus 29 (17%) 1041 (7%) 0.000
Serum creatinine* (mg/dL) 1.39
/0.6 1.19/0.7 0.000
BUN* (mg/dL) 52.79
/37.0 35.79/17.1 0.000
LVEF* (%) 58.39
/12.3 62.89/9.8 0.005
LVEDP* (mmHg) 13.29
/5.1 12.29/5.4 0.062
Preoperative inotropic 2 (1.1%) 62 (0.4%) 0.171
support
Preoperative IABP support 2 (1.1%) 68 (0.4%) 0.196
ARF, acute renal failure; LVEF, left ventricular ejection fraction; LVEDP, left ventricular end-diastolic pressure; IABP, intra-aortic balloon
pump; (*), preoperative values.
Renal failure after open heart surgery
I Bahar
et al
.
318
perioperatively (control group; p/0.000). There
were no survivors among those 52 patients (30.9%)
who developed low cardiac output syndrome or
deep sternal/systemic infection, perioperatively.
The mean follow-up period of survivors in the
ARF group was 5.79/3.2 years (range: 4 months to
13 years; a total of 195 patient-years), and 10-year
survival was 599
/10% in the discharged patients
(Figure 1).
A comparison between the ARF and control
groups is presented in Tables 1 and 2. Univariate
analysis revealed that age (p/0.000), hypertension
(p
/0.000), diabetes mellitus (p/0.000), high pre-
operative BUN (p
/0.000) and creatinine (p/0.000)
levels, a low preoperative LVEF (p
/0.000), urgent
operation (p
/0.000) or reoperation (p/0.007),
concomitant valvular or vascular procedures (p
/
0.000), prolonged cardiopulmonary bypass (CPB)
Table 2 Perioperative variables
Procedure/variable ARF group ( n
/168) Control group ( n/14 269) p value
CABG
/concomitant VR 7 (4.2%) 199 (1.4%) 0.000
CABG
/concomitant PAS 11 (6.6%) 169 (1.2%) 0.000
Aortic surgery 12 (7.1%) 249 (1.7%) 0.000
Urgent operation 18 (11%) 286 (2%) 0.000
Reoperation 12 (7.1%) 478 (3.3%) 0.007
CPB duration (min) 126.29
/81.3 77.69/42.4 0.000
ACC duration (min) 61.59
/34.2 45.59/24.5 0.000
Hypothermia (8C) 28.69
/3.6 30.69/2.3 0.000
Re-exploration in the ICU 72 (42.9%) 485 (3.4%) 0.000
Deep/systemic infection 79 (47.0%) 100 (0.7%) 0.000
Inotropic support need 135 (80%) 3058 (21%) 0.000
IABP installation 65 (38%) 537 (3%) 0.000
Mortality 134 (79.7%) 683 (4.8%) 0.000
ARF, acute renal failure; CABG, coronary artery bypass grafting; VR, valve replacement; PAS, peripheral arterial surgery; CPB,
cardiopulmonary bypass; ACC, aortic cross-clamping; IABP, intra-aortic balloon pump; ICU, intensive care unit.
Table 3 Relative risk analysis of patients according to risk factors
Procedure/variable ARF group ( n
/168) (%) Control group ( n/14 269) (%) Relative risk
Age
/50 years 1.7 0.6 2.83
Age
/70 years 4.0 1.0 4.00
Hypertension 2.2 0.9 2.4
Diabetes mellitus 2.2 1.0 2.2
Creatinine (
/1.2 mg/dL) 2.8 0.9 3.1
BUN (
/50 mg/dL) 3.8 0.8 4.7
LVEF (B
/50%) 3.0 1.2 2.5
LVEDP (
/12 mmHg) 1.5 1.1 1.3
CPB duration (
/120 min) 4.0 0.8 5.0
ACC duration (
/60 min) 1.9 0.9 2.1
Hypothermia (B
/288C) 2.8 0.8 3.5
Reoperation 2.4 1.1 2.1
Urgent operation 5.9 1.1 5.3
Inotropic support need 3.3 0.3 11.0
IABP installation 10.8 0.7 15.4
Re-exploration in the ICU 13.0 0.7 18.5
Deep/systemic infection 18.2 0.6 30.3
ARF, acute renal failure; LVEF, left ventricular ejection fraction; LVEDP, left ventricular end-diastolic pressure; LVPS, left ventricular
performance score; CPB, cardiopulmonary bypass; ACC, aortic cross-clamping; IABP, intra-aortic balloon pump.
Table 4 ARF incidence in the presence of the first four risk factors
Postoperative inotrope Postoperative IABP Revision Infection Incidence (%)
Not present Not present Not present Not present 0.2
Present Present Not present Not present 5.7
Present Present Present Not present 7.5
Present Present Not present Present 20
Present Present Present Present 26.7
ARF, acute renal failure; IABP, intra-aortic balloon pump.
Renal failure after open heart surgery
I Bahar
et al
.
319
duration (p/0.000) and aortic cross-clamping
(ACC) duration (p
/0.000), level of hypothermia
(below 288C; p
/0.000), inotropic and/or mechan-
ical IABP support requirement (p
/0.000), re-
exploration for bleeding/tamponade (p
/0.000),
and development of deep sternal or systemic infec-
tion (p
/0.000) were the risk factors for periopera-
tive ARF development.
All these variables were entered in an analysis for
a relative risk determination (Table 3). This relative
risk analysis revealed 2.83 times increased relative
risk in those older than 50 years of age. The risk
increased four times for those over 70 years of age.
Postoperative inotropic and IABP support, re-ex-
ploration for bleeding and/or tamponade, and the
presence of systemic/deep sternal infection were the
four most frequent risk factors. The ARF incidence
following open-heart surgery increases to 26.7%
when all these four were together (Table 4). The
factors determined by univariate analysis were
further analysed by a multiple stepwise backward
logistic regression model. Consequently, age, pre-
operative BUN level, CPB duration, degree of
hypothermia, reoperation, postoperative IABP re-
quirement, re-exploration for bleeding and tampo-
nade and systemic/deep sternal infection were
found to be independent risk factors (Table 5) for
ARF development after open-heart procedures.
For the hospital survivors, the leading cause of
death during follow-up was cardiac, and the 10-year
Kaplan
/Meier survival rate was 58.69/10.2%
(Figure 1) among those who were discharged from
the hospital. The mean follow-up period was 5.79
/
3.2 years (range: 4 months to 13 years; a total of 195
patient-years). Of the 34 discharged patients in the
ARF group, renal functions recovered to normal in
21 patients (12.5%). Unfortunately, in eight patients
(4.7%), chronic renal failure ensued and these
patients became hemodialysis-dependent in the
long-term follow-up. Five patients (2.9%) were lost
during the follow-up within the first postoperative
year due to cardiac events such as congestive heart
failure and ventricular fibrillation, except one pa-
tient who died due to neurologic events.
Discussion
Acute renal failure is among the most drastic
complications after open-heart surgery and warrants
vigorous investigation, especially on potential risk
factors and the treatment modalities, as well as both
short- and long-term prognosis. Following open-
heart surgery, it is rarely an isolated entity, but
rather a part of multi-organ failure caused by
conditions such as systemic infection or low cardiac
output syndrome. In many cases, it is reversible in
the beginning and may rapidly recover with appro-
priate therapy. The triggering event is often an
extreme change in hemodynamics, which results
in the low cardiac output state; however, cardiopul-
monary bypass may also lead to ARF as a sole
precipitator,
5,6
since glomerular filtration rate de-
creases by 30% during cardiopulmonary bypass.
7
With the addition of hypothermia, vasoconstriction
and exposure to the microemboli generated by the
activated cascades, structural and functional
changes in kidneys may quickly ensue. These
changes start as a mild cortical or medullar edema,
and may proceed with the breakdown of tubular
cells and result in necrosis which is manifested by
clinical symptoms and abnormal serum BUN and
creatinine levels as a consequence of a 30
/40%
decrease in the amount of nephrons. After this,
nitrogenous product accumulation in the serum
becomes evident.
1,6,8
An accompanying infection
generally indicates a grave prognosis due to sys-
temic pathology and circulating endo/exotoxins, as
well as the renal side-effects of some antibiotics
(aminoglicozyides, vancomycin etc.). All these
Table 5 Logistic regression analysis
Factor p value Odds ratio 95% C.I.
Age 0.007 1.022 1.006
/1.038
BUN 0.001 1.011 1.005
/1.017
CPB time 0.003 1.005 1.002
/1.008
Hypothermia 0.001 0.884 0.822
/0.951
Reoperation 0.012 2.556 1.233
/5.296
IABP installation 0.000 4.254 2.612
/6.925
Re-exploration in the ICU 0.014 2.142 1.167
/3.930
Deep/systemic infection 0.000 7.968 4.447
/14.277
Constant 0.004 0.025
CPB, cardiopulmonary bypass; IABP, intra-aortic balloon pump.
10
8642
0
100
80
60
40
20
% survival
Postoperative years
Figure 1 Survival after discharge in patients who underwent
hemodialysis in the early postoperative period after open heart
surgery.
Renal failure after open heart surgery
I Bahar
et al
.
320
factors, by working together, may increase the
mortality to 95
/100%.
2,3,6,9
From this prospect, it is quite understandable why
old age is a risk factor, since a substantial decrease
in glomerular filtration rate often begins after the
fourth decade.
10
In our study, we observed that
relative risk for developing ARF had progressively
increased for every five years aging after 50 years of
age. Thus, we concluded that, especially after the
seventh decade, a patient’s renal function reserve
should be carefully evaluated. Patients with dia-
betes mellitus, amiloidosis, a history of previous
nephritic attacks, and preoperative renal dysfunc-
tions are also at risk due to decreased nephron
reserves. These patients should be closely moni-
tored for their propensity to develop ARF after open-
heart surgery.
2,5,11
Prolonged CPB periods increase
the exposure time to deleterious effects of non-
physiologic extracorporeal circulation conditions,
while prolonged aortic clamping times mean an
increased risk for low cardiac output state develop-
ment. Although the exact safe period is difficult to
determine, it has been reported that the risk had
been increased by 10
/15 times after 60 min of
cardiopulmonary bypass.
3,6,12
Our results support
these hypotheses. Inadequate volume replacement
after extravascular leak during CPB, or bleeding in
the early postoperative period, may also precipitate
renal failure by prerenal mechanisms. Conversely,
massive transfusion, especially when associated
with hypothermia, which may further aggravate
coagulopathy, also leads to renal failure by
triggering certain pathways and cascades, as well
as erythrocyte debris precipitation in the renal
tubules.
3,6,7,16,17
Although deep levels of core cool-
ing have been reported not to influence periopera-
tive renal function in many recent studies,
18,19
we
found that hypothermia below 288C is associated
with an increased risk. Preoperative left ventricular
dysfunction, even when the arterial blood pressure
is kept in the normal range, negatively influences
renal perfusion by affecting renal flow para-
meters.
6,7,13
In addition, prolonged high-dose use
of inotropics may also deteriorate renal perfusion
seriously in this subset of patients.
6,14,15
In the presence of more than one risk factor, the
risk increases tremendously. In a patient with low
cardiac output syndrome, if explored in the ICU for
bleeding/tamponade and developed systemic infec-
tion, the mortality rate increases up to 100%.
Avoiding nephrotoxic agents, close observation of
serum creatinine level, a brisk volume replacement
therapy, optimizing hemodynamics, nutritional sup-
port with aminoacid solutions, and timely use of
hemodialysis or veno-venous hemodiafiltration
when deemed necessary, are the key elements of
management.
10,12,15,20 23
In conclusion, recognizing the risk factors, careful
perioperative renal monitoring in those under risk,
and timely management with today’s advanced
therapeutic modalities where a threat is imminent
should substantially decrease the incidence of this
fearful complication. For those discharged from
hospital, the main cause of death in the postopera-
tive period remains cardiac, and 10-year survival
rate is 58.69
/10.2%.
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    • "Overall, nephrotoxic medications contribute to up to 66% of all AKIs in older hospitalized patients [137]. Older age qualified as independent predictor of AKI in several different population studies [138][139][140][141][142][143][144][145]. In particular, Mangano et al showed that the relative risk of developing AKI after myocardial revascularization with or without concurrent valvular surgery was 1.6 (95% CI, 1.1 to 2.3) among patients aged 70-79 years, and 3.5 (95%CI, 1.9 to 6.3) among patients aged 80-95 years compared to those aged less than 70 [146]. "
    [Show abstract] [Hide abstract] ABSTRACT: During aging, kidneys undergo relevant modifications in glomerular, tubulo-interstitial and vascular structure and function, which increase the vulnerability to iatrogenic kidney damage among older individuals. The purpose of this paper was to summarize current evidence about mechanisms, clinical features, diagnostic issues, and strategies for prevention of medication-induced nephrotoxicity among older people, in an attempt to provide both researchers and clinicians an updated review on this topic. To this aim, a thorough literature search was performed and 247 papers were included in the review. Medications may induce nephrotoxicity through several mechanisms, including hemodynamically mediated damage, tubular epithelial cells injury, tubulo-interstitial disease, glomerular disease, obstructive nephropathy, vasculitis and thrombosis. Besides being more vulnerable to nephrotoxicity due to age-related changes in the kidney, people aged 75 or more are especially exposed to potential nephrotoxic medications or combinations of medications in the context of complex polypharmacy regimens. Clinical manifestations of nephrotoxicity include both acute kidney injury (AKI) and chronic kidney disease (CKD). Estimated glomerular filtration rate (eGFR) may be useful to identify medication-induced alterations in kidney function, but creatinine-based methods have important limitation in older patients. Several innovative biomarkers have been proposed to identify AKI but these methodologies are not standardized and older people have not been evaluated systematically. Factors related to patient, medication, and interactions should be taken into account for effective prevention.
    Full-text · Article · Apr 2016
    • "Ameliyat sonrası gelişen ABH ve ABY yüksek mortalite, hastanede uzun kalış süresi ve artmış sağlık harcamaları ile belirgin şekilde ilişkilidir.891011Çalışmamızda PDAK ve KABG grupları karşılaştırıldığında ; iki grup arasında, hastane yatış süreleri ve ventilatöre bağlı kalma süreleri açısından istatistiksel anlamlı fark yok iken, yoğun bakım ünitesi kalış süreleri açısından KABG grubunda istatistiksel anlamlı artış vardı (p= 0.011). "
    Full-text · Article · Dec 2015
    • "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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jun 2014
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