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Hemodilution is associated with underestimation of serum creatinine in cardiac surgery patients: a retrospective
Jifu Jin1,2,3,4,5, Jiarui Xu1,2,3,4, Sujuan Xu1,2,3,4
1Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Insights
Fluid overload can skew serum creatinine measurements in cardiac surgery patients. Underestimating creatinine due to fluid balance is linked to worse outcomes, highlighting the need for accurate AKI assessment.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Fluid overload is a significant factor in cardiac surgery-associated acute kidney injury (CSA-AKI) development and prognosis.
- Accurate assessment of kidney function is crucial for managing CSA-AKI.
Purpose of the Study:
- To investigate the impact of fluid balance-corrected serum creatinine (SCr) on the prognosis of patients undergoing cardiac surgery.
- To evaluate how fluid overload influences the detection and outcomes of CSA-AKI.
Main Methods:
- A retrospective analysis of 1334 patients undergoing elective cardiac surgery.
- Application of Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI identification.
- Adjustment of SCr for cumulative fluid balance to define creatinine underestimation (∆Crea ≥ P75), normal (P25 < ∆Crea < P75), and overestimation (∆Crea ≤ P25) groups.
Main Results:
- The incidence of AKI increased from 29.5% to 31.8% after fluid balance adjustment.
- The underestimation group experienced significantly longer ICU stays (3.2 days) compared to normal (2.1 days) and overestimation (2.3 days) groups.
- Underestimation was independently associated with age, baseline SCr, and left ventricular ejection fraction.
Conclusions:
- Cumulative fluid balance can lead to inaccurate SCr measurements in post-cardiac surgery patients.
- Underestimation of SCr, influenced by fluid balance, is associated with poorer patient prognosis, including prolonged hospital and mechanical ventilation durations.
Background:
Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery.
Methods:
A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 h during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25).
Results:
The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2 [1.0-4.0] vs 2.1 [1.0-3.0] d, P < 0.001; 3.2 [1.0-4.0] vs 2.3 [1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine.
Conclusions:
Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.
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