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Risk Factors for Acute Kidney Injury in Coronary Artery Bypass Graft Surgery Patients Based on the Acute Kidney
Khosro Barkhordari1, Ali Mohammad Fakhre Yasseri2, Fardin Yousefshahi3,4
1Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Older age, higher BMI, and longer bypass times increase the risk of acute kidney injury (AKI) after heart surgery. Blood transfusions in the ICU and lack of intraoperative transfusion are also key factors.
Area of Science:
- Cardiology
- Nephrology
- Surgical Complications
Background:
- Acute kidney injury (AKI) is a frequent complication following coronary artery bypass graft (CABG) surgery.
- Identifying risk factors for AKI is crucial for patient management and outcomes.
Purpose of the Study:
- To determine independent risk factors for AKI in patients undergoing isolated CABG surgery.
- To utilize the Acute Kidney Injury Network (AKIN) classification for AKI assessment.
Main Methods:
- A cross-sectional study of 3473 isolated post-CABG patients.
- Analysis of 29 potential risk factors using logistic regression.
- Patients categorized into AKI-negative and AKI-positive groups based on creatinine levels and AKIN criteria.
Main Results:
- 27.7% of patients developed AKI (Stage 1 or higher).
- Independent risk factors identified: older age, higher body mass index, lower preoperative creatinine, longer cardiopulmonary bypass time, blood transfusion in ICU, and lack of intraoperative blood transfusion.
- Specific odds ratios (OR) and p-values were calculated for each risk factor.
Conclusions:
- Older age, elevated BMI, and longer cardiopulmonary bypass times are significant risk factors for AKI post-CABG.
- Blood transfusion management (ICU vs. intraoperative) impacts AKI risk.
- Lower preoperative creatinine levels are associated with a reduced risk of AKI.
Abstract:
Background: Acute kidney injury (AKI) after coronary artery bypass graft surgery (CABG) is a common complication. The present study sought to determine AKI risk factors based on the Acute Kidney Injury Network (AKIN) classification. Methods: In a cross-sectional study, performed from March 2010 to April 2012 at Tehran Heart Center, affiliated with Tehran University of Medical Sciences, 29 independent risk factors for AKI based on the AKIN criteria were examined in isolated post-CABG patients. The patients' demographic data and risk factors were extracted from the Electronic Database of Tehran Heart Center. According to restricted inclusion and exclusion criteria as well as a creatinine rise to AKI Stage 1, the patients were divided into 2 groups of AKI-negative and AKI-positive and the risk factors were compared between these groups. Results: Out of 3473 included patients at a mean age of 60.78 (±9.46) years, the majority (2474 [71.23%]) were male. Totally, 958 (27.7%) patients had AKI, according to a creatinine rise to AKI Stage 1. Logistic regression analysis demonstrated that higher age (OR=1.021; P<0.001), higher body mass index (OR=1.035; P<0.001), lower preoperative creatinine level (OR=0.417; P<0.001), longer cardiopulmonary bypass time (OR=1.004; P=0.007), blood transfusion in the ICU (OR=1.408; P=0.001), and lack of intraoperative blood transfusion (OR=0.823; P=0.044) were the independent risk factors for AKI after CABG. Conclusion: Based on the findings of the current study, older age, higher body mass index, lower preoperative creatinine level, more blood transfusion in the intensive care unit (ICU), lack of intraoperative blood transfusion, and high cardiopulmonary bypass time may serve as risk factors for the development of AKI in CABG patients.
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