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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Associations Between Base Excess, Alactic Base Excess, and Kidney Function Deterioration in Patients Undergoing
Zheng Li1, Da Qian2, Yanfei Xia3
1Department of Endocrinology, Zhejiang Hospital, Hangzhou, P.R. China.
Insights
Lower base excess (BE) and alactic base excess (aBE) levels are linked to a higher risk of kidney function deterioration after coronary artery bypass grafting (CABG) surgery. These measures may serve as early indicators of kidney injury in these patients.
Area of Science:
- Nephrology and Critical Care Medicine
- Cardiovascular Surgery and Anesthesiology
Background:
- Kidney function deterioration is a significant complication following coronary artery bypass grafting (CABG) surgery.
- Identifying early markers for kidney injury in CABG patients is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To investigate the association between base excess (BE) and alactic base excess (aBE) and the risk of kidney function deterioration in patients undergoing CABG surgery.
- To determine if BE and aBE can serve as predictive markers for acute kidney injury (AKI) and its recovery post-CABG.
Main Methods:
- Retrospective cohort study utilizing the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.
- Analysis included 5,634 patients undergoing CABG surgery.
- Logistic regression models were employed to assess the relationship between baseline BE and aBE levels and kidney function deterioration, adjusting for multiple clinical covariates.
Main Results:
- Lower baseline BE (≤2.61) and aBE (≤1.038) were significantly associated with an increased incidence of kidney function deterioration (OR=1.22, 95% CI: 1.05-1.41 and OR=1.19, 95% CI: 1.02-1.38, respectively).
- Lower aBE (≤1.038) was linked to a higher incidence of new-onset AKI (OR=1.26, 95% CI: 1.01-1.57).
- In patients with baseline AKI, lower BE and aBE were associated with increased odds of AKI recovery (OR=1.88, 95% CI: 1.47-2.41 and OR=1.82, 95% CI: 1.42-2.33, respectively).
Conclusions:
- Reduced base excess and alactic base excess levels are independently associated with a higher risk of kidney function deterioration in patients undergoing CABG.
- BE and aBE show potential as early biomarkers for detecting kidney injury in the perioperative period of CABG surgery.
Objectives:
To explore the relationship between base excess (BE), alactic BE (aBE), and the deterioration of kidney function in patients undergoing coronary artery bypass grafting (CABG) surgery.
Design:
A retrospective cohort study.
Setting:
The Medical Information Mart for Intensive Care IV (MIMIC-IV) database.
Participants:
Patients undergoing CABG surgery.
Interventions:
None.
Measurements And Main Results:
The outcome was kidney function deterioration, including new-onset acute kidney injury (AKI) and increased severity of AKI. Univariate and multivariate logistic regression models were conducted to explore the associations between baseline BE, aBE levels, and kidney function deterioration in patients undergoing CABG surgery. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Covariates were adjusted for, including sepsis, weight, pulse oximetry-derived oxygen saturation, Simplified Acute Physiology Score II, Charlson Comorbidity Index, partial thromboplastin time, vasopressor use, loop diuretics, blood infusions, and acetaminophen use. In total, 5,634 individuals were included who underwent CABG surgery. BE ≤2.61 (OR= 1.22, 95% CI: 1.05-1.41) and aBE ≤1.038 (OR = 1.19, 95% CI: 1.02-1.38) were related to the higher incidence of kidney function deterioration. aBE ≤1.038 (OR = 1.26, 95% CI: 1.01-1.57) was linked to a higher incidence of new onset of AKI. In patients who had AKI at baseline, BE ≤2.61 (OR = 1.88, 95% CI: 1.47-2.41) and aBE ≤1.038 (OR = 1.82, 95% CI: 1.42-2.33) were also related to increased odds of AKI recovery. The relationships between lower BE and aBE and higher odds of kidney function deterioration were also found in those aged ≥65 years, males, patients without chronic kidney disease, patients given vasopressors, and those not administered loop diuretics, nephrotoxic antibiotics, blood infusions, and acetaminophen.
Conclusion:
Lower BE and aBE values are associated with an increased risk of kidney function deterioration in patients undergoing CABG surgery. BE and aBE could serve as early markers of kidney injury.
