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Acute kidney injury following cardiopulmonary bypass in Jamaica
Lori-Ann Fisher1,2, Sunil Stephenson3, Marshall Tulloch Reid2
1Department of Medicine, The University of the West Indies, Mona, Jamaica.
Insights
Acute kidney injury (AKI) after cardiopulmonary bypass is common in Jamaica, affecting 38.1% of patients. AKI significantly increases hospital stay and 30-day mortality, highlighting a critical need for intervention.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a significant complication following cardiopulmonary bypass (CPB).
- Understanding the incidence and risk factors of AKI post-CPB is crucial for improving patient outcomes.
- Data on AKI in the Caribbean, specifically Jamaica, is limited.
Purpose of the Study:
- To determine the incidence of AKI after CPB in Jamaica.
- To identify risk factors associated with AKI development post-CPB.
- To describe the outcomes, including mortality, for patients experiencing AKI after CPB.
Main Methods:
- Retrospective review of medical records for adult patients undergoing CPB from January 2016 to June 2019.
- AKI diagnosis based on Kidney Disease Improving Global Outcomes (KDIGO) criteria.
- Multivariable logistic regression and Cox proportional hazard analyses to identify risk factors and mortality predictors.
Main Results:
- AKI occurred in 38.1% of 210 patients, with varying KDIGO stages.
- Risk factors for AKI included higher EuroSCORE II, longer bypass time, red cell transfusion, and elevated postoperative neutrophil-lymphocyte ratio.
- AKI was associated with significantly longer hospital and ICU stays and an 8-fold increase in 30-day mortality.
Conclusions:
- AKI is a frequent and severe complication after CPB in Jamaica, leading to adverse short-term outcomes.
- The findings underscore the urgent need for targeted interventions to mitigate AKI and reduce mortality in this population.
- Further research and quality improvement initiatives are recommended for the Caribbean region.
Objectives:
The study objectives were to describe the incidence, risk factors, and outcomes of acute kidney injury after cardiopulmonary bypass in Jamaica.
Method:
We performed a review of the medical records of adult patients (aged ≥ 18 years) with no prior dialysis requirement undergoing cardiopulmonary bypass at the University Hospital of the West Indies, Mona, between January 1, 2016, and June 30, 2019. Demographic, preoperative, intraoperative, and postoperative data were abstracted. Acute kidney injury was defined using Kidney Disease Improving Global Outcomes criteria. The primary outcomes were acute kidney injury incidence and all-cause 30-day mortality. Multivariable logistic regression and Cox proportional analyses were used to examine the association between the acute kidney injury risk factors and the primary outcome.
Results:
Data for 210 patients (58% men, mean age 58.1 ± 12.9 years) were analyzed. Acute kidney injury occurred in 80 patients (38.1%), 44% with Kidney Disease Improving Global Outcomes I, 33% with Kidney Disease Improving Global Outcomes II, and 24% with Kidney Disease Improving Global Outcomes III. From multivariable logistic regression models, European System for Cardiac Operative Risk Evaluation II (odds ratio, 1.19; 95% confidence interval, 1.01-1.39 per unit), bypass time (odds ratio, 1.94; 95% confidence interval, 1.40-2.67 per hour), perioperative red cell transfusion (odds ratio, 3.03; 95% confidence interval, 1.36-6.76), and postoperative neutrophil lymphocyte ratio (odds ratio, 1.65; 95% confidence interval, 1.01-2.68 per 10-unit difference) were positively associated with acute kidney injury. Acute kidney injury resulted in greater median hospital stay (18 vs 11 days, P < .001) and intensive care unit stay (5 vs 3 days, P < .001), and an 8-fold increase in 30-day mortality (hazard ratio, 8.15; 95% confidence interval, 2.76-24.06, P < .001).
Conclusions:
Acute kidney injury after cardiopulmonary bypass surgery occurs frequently in Jamaica and results in poor short-term outcomes. Further studies coupled with quality interventions to reduce the mortality of those with acute kidney injury are needed in the Caribbean.
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