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[A long-term outcome study of acute kidney injury after cardiac surgery]
Jun Jiang1, Xiaoqiang Ding1, Wuhua Jiang1
1Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Insights
Acute kidney injury (AKI) after cardiac surgery significantly reduces 2-year survival and increases advanced chronic kidney disease (CKD) risk. Early intervention and monitoring are crucial for improving patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a recognized complication following cardiac surgery.
- Long-term consequences of AKI in this patient population require further investigation.
Purpose of the Study:
- To evaluate the long-term outcomes, specifically 2-year survival rates and the incidence of advanced chronic kidney disease (CKD), in patients who developed AKI after cardiac surgery.
- To identify factors influencing mortality and advanced CKD development post-cardiac surgery.
Main Methods:
- A cohort of 1,770 patients undergoing cardiac surgery was analyzed.
- Patients were classified into AKI and non-AKI groups based on KDIGO guidelines.
- Two-year follow-up was conducted to assess survival and advanced CKD incidence.
Main Results:
- 40.4% of patients developed AKI.
- The 2-year survival rate was significantly lower in the AKI group (83.2%) compared to the non-AKI group (93.6%).
- The incidence of advanced CKD at 2 years was substantially higher in the AKI group (6.7%) versus the non-AKI group (0.2%).
- AKI was identified as an independent risk factor for both mortality and advanced CKD.
Conclusions:
- Acute kidney injury is a common and serious complication after cardiac surgery.
- AKI is associated with decreased long-term survival and increased risk of developing advanced chronic kidney disease.
- Emphasizes the critical need for AKI prevention, timely treatment, and vigilant renal function monitoring to improve patient prognosis.
Objective:
To evaluate the long-term outcome of acute kidney injury (AKI) during hospitalization after cardiac surgery.
Methods:
1 770 patients underwent cardiac surgery in Fudan University Zhongshan Hospital from April 2009 to February 2011 were enrolled. Based on the Kidney Disease: Improving Global Outcomes (KDIGO) guideline of AKI, the patients were divided into the AKI and the non-AKI groups, and followed up for 2 years. The 2-year survival rate and incidence of the advanced chronic kidney disease (CKD) was compared between the two groups.Factors influencing the 2-year survival rate and incidence of the advanced CKD were also analyzed.
Results:
Among all the patients, 715 (40.4%) of them were developed AKT. (1) The 2-year survival rate of the AKI group was lower than that of the non-AKI group (83.2% vs 93.6%;P < 0.05). Compared with the non-AKI group, AKI group had an increased risk for death with the hazard ratio of 1.710 (95%CI 1.250-2.340). COX regression analysis showed that AKI was an independent factor for death with the risk intensity just less than diabetes and chronic cardiac insufficiency. The advanced age, the preoperative history of chronic cardiac insufficiency and the time of staying in ICU also significantly increased the risk of death. (2) Compared with patients without AKI (0.2%), the incidence of the 2-year of advanced CKD was higher in patients with AKI (6.7%;P < 0.05) with an hazard ratio of 31.220 (95%CI 7.550-129.110). COX regression analysis showed that AKI was still the independent risk factor for advanced CKD after adjustment of other factors.In addition, diabetes, the time of the cardiopulmonary bypass and the time of staying in ICU were also associated with the risk for the advanced CKD.
Conclusions:
AKI is common after cardiac surgery, which was associated with a decrease in the 2-year survival rate and an increase in the incidence of advanced CKD of patients, which emphasized the importance of prevention and treatment of AKI, and close follow-up of renal function for the improvement of patient long-term prognosis.
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