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Acute Kidney Injury Classification Underestimates Long-Term Mortality After Cardiac Valve Operations

Hjalmar R Bouma1, Hubert E Mungroop2, A Fred de Geus2

  • 1Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands; Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands.

The Annals of Thoracic Surgery
|March 5, 2018
PubMed

Insights

Perioperative acute kidney injury (AKI) increases long-term mortality risk after cardiac valve operations. Even minor creatinine increases below AKI stage 1 indicate higher mortality, suggesting AKI classification underestimates risk.

Area of Science:

  • Nephrology
  • Cardiology
  • Cardiac Surgery

Background:

  • Perioperative acute kidney injury (AKI) predicts long-term mortality after coronary artery bypass grafting (CABG).
  • The impact of AKI on long-term mortality following cardiac valve operations remains undocumented.

Purpose of the Study:

  • To investigate the association between perioperative renal injury and long-term all-cause mortality in patients undergoing cardiac valve operations.
  • To compare mortality risks in patients undergoing solitary valve operations versus valve operations combined with CABG, using solitary CABG as a reference.

Main Methods:

  • A prospective cohort study included patients undergoing solitary valve operations (n=2,806), valve operations with CABG (n=1,260), and solitary CABG (n=4,938).
  • Renal injury was assessed by postoperative serum creatinine increase, classified using AKI stages 0-3.
  • Follow-up extended up to 18 years.

Main Results:

  • Postoperative renal injury (AKI stage 1+) was progressively associated with increased long-term mortality in both valve and valve+CABG groups.
  • A serum creatinine increase of 10%-25% (below AKI stage 1 threshold) significantly elevated mortality risk after valve operations (HR, 1.39; p<0.05).
  • This sub-AKI threshold increase did not significantly impact mortality in valve+CABG or solitary CABG groups.

Conclusions:

  • A serum creatinine increase >10% within the first week post-valve operation signifies elevated long-term mortality risk.
  • Standard AKI classification underestimates the long-term mortality risk in patients undergoing cardiac valve operations.
Abstract

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