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Identification of modifiable risk factors for acute kidney injury after cardiac surgery
S Vellinga1, W Verbrugghe, R De Paep
1Department of Nephrology-Hypertension, Antwerp University Hospital, Belgium.
Insights
Cardiac surgery-associated acute kidney injury (CS-AKI) risk factors include intraoperative packed cell transfusions and postoperative furosemide or packed cells. Identifying these modifiable factors can improve patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Surgical Critical Care
Background:
- Acute kidney injury (AKI) following cardiac surgery is a significant clinical challenge, increasing morbidity, mortality, and hospital stay.
- Identifying risk factors for cardiac surgery-associated AKI (CS-AKI) is crucial for developing preventative strategies.
Purpose of the Study:
- To identify potential risk factors for CS-AKI in a single-center population.
- To specifically focus on modifiable risk factors associated with CS-AKI.
Main Methods:
- A retrospective single-center cohort study involving 565 consecutive patients undergoing isolated coronary artery bypass grafting (CABG) with cardiopulmonary bypass.
- AKI was defined using the AKIN classification; known risk scores were applied where feasible.
Main Results:
- 14.7% of patients developed CS-AKI.
- Significant differences were observed in age, preoperative eGFR, CKD stage, and surgical urgency between CS-AKI and control groups.
- Intraoperative packed cell transfusion and postoperative furosemide or packed cell administration were associated with CS-AKI.
Conclusions:
- Intraoperative packed cell administration and postoperative furosemide or packed cell administration are potentially modifiable risk factors for CS-AKI.
- These findings highlight targets for intervention to reduce the incidence of CS-AKI.
Objectives:
Acute kidney injury (AKI) is a common problem after cardiac surgery and is associated with an increase in morbidity, mortality and duration of hospital stay. With this study we aimed to identify potential risk factors for cardiac surgery associated AKI (CS-AKI) in a single-centre population with a special focus on modifiable risk factors.
Methods:
Retrospective single-centre cohort study of 565 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) with the use of cardiopulmonary bypass. AKI was defined by the AKIN classification. Known risk scores were applied when possible.
Results:
Of the population, 14.7% were diagnosed with AKI. When considering baseline characteristics we found a significant difference in age, preoperative estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) stage and urgency of surgery between the CS-AKI group and the control population. Regarding the intraoperative characteristics, patients with CS-AKI had a significantly lower haematocrit and were more likely to receive a transfusion of packed cells. Postoperative administration of furosemide and packed cell transfusions were also associated with AKI. We found no differences in other characteristics (history of diabetes mellitus, history of congestive heart failure, sex, body mass index (BMI), history of cardiac surgery, low cardiac output and need for intra-aortic balloon pump (IABP), duration of cardiopulmonary bypass (CPB) and cross clamping).
Conclusion:
In our series we could identify intraoperative administration of packed cells and postoperative administration of furosemide or packed cells as potentially modifiable risk factors in the development of AKI.
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