Mild AKI is associated with mortality of patients who underwent cardiopulmonary bypass surgery
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Published on: November 3, 2023
Yanli Yang1, Jun Ma1
1Department for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China.
Insights
Acute kidney injury (AKI) stage I, common after heart surgery, significantly increases patient mortality risk. This early stage of kidney injury is independently linked to higher death rates, emphasizing its clinical importance.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is frequently observed in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
- AKI stage I represents the most common presentation of AKI in this patient population.
- The prognostic implications of early-stage AKI following cardiovascular procedures warrant detailed investigation.
Purpose of the Study:
- To investigate the association between AKI stage I and mortality in patients who underwent cardiac surgery with CPB.
- To determine if AKI stage I is an independent predictor of mortality in this cohort.
- To explore the impact of AKI recovery on survival outcomes.
Main Methods:
- Retrospective review of 1,846 adult patients undergoing cardiac surgery with CPB between July 2013 and May 2014.
- Dichotomization of patients into AKI stage I and non-AKI groups.
- Kaplan-Meier survival analysis and multivariate Cox regression to assess mortality risk.
Main Results:
- 338 patients (18.3%) developed AKI stage I.
- Kaplan-Meier analysis revealed a significantly increased mortality risk for patients with AKI stage I (P<0.0001).
- Multivariate analysis confirmed AKI stage I as an independent predictor of reduced survival; non-recovery AKI showed higher mortality (P<0.0001).
Conclusions:
- AKI stage I is the predominant form of AKI post-cardiac surgery with CPB.
- AKI stage I is independently associated with increased all-cause mortality.
- AKI recovery status is a critical factor influencing survival in these patients.
Abstract:
Acute kidney injury (AKI) stage I is the most common stage of AKI observed among patients who underwent cardiac surgery with cardiopulmonary bypass (CPB). The relationship between AKI stage I and mortality requires further investigation. Patients aged 18 years or older who underwent cardiac surgery with CPB between July 1, 2013 and May 31, 2014, were reviewed in the present study. Patients were dichotomized into: i) The AKI stage I group, and ii) the non-AKI group. The primary measured characteristic in the present study was the relationship between AKI and mortality. Kaplan-Meier survival analyses were taken to obtain survival curves. A total of 1,846 patients were included in this present study. The mean age was 51.76±13.56 years. A total of 1,508 patients did not develop AKI and 338 developed AKI stage I. The mean follow-up period among survivors was 9.95±3.45 months. Kaplan-Meier survival analyses showed that patients with AKI stage I were at an increased mortality risk (P<0.0001). In multivariate Cox regression analysis, AKI stage I remained independently associated with a reduced survival. Using a subgroup analysis, patients with non-recovery AKI (defined as non-recovery AKI if the serum level does not return before surgery) had a higher mortality rate than patients with recovery AKI (P<0.0001). AKI stage I is the most common form of AKI and it is independently related to all-cause mortality in patients who underwent cardiovascular surgery with cardiopulmonary bypass.
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