Acute kidney injury after cardiac surgery: focus on modifiable risk factors.

Abstract

BACKGROUND:

Acute kidney injury (AKI) after cardiac surgery is a major health issue. Lacking effective therapies, risk factor modification may offer a means of preventing this complication. The objective of the present study was to identify and determine the prognostic importance of such risk factors.

METHODS AND RESULTS:

Data from a multicenter cohort of 3500 adult patients who underwent cardiac surgery at 7 hospitals during 2004 were analyzed (using multivariable logistic regression modeling) to determine the independent relationships between 3 thresholds of AKI (>25%, >50%, and >75% decrease in estimated glomerular filtration rate within 1 week of surgery or need for postoperative dialysis) with death rates, as well as to identify modifiable risk factors for AKI. The 3 thresholds of AKI occurred in 24% (n=829), 7% (n=228), and 3% (n=119) of the cohort, respectively. All 3 thresholds were independently associated with a >4-fold increase in the odds of death and could be predicted with several perioperative variables, including preoperative intra-aortic balloon pump use, urgent surgery, and prolonged cardiopulmonary bypass. In particular, 3 potentially modifiable variables were also independently and strongly associated with AKI. These were preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration.

CONCLUSIONS:

AKI after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication.

• Authors: Keyvan Karkouti, Duminda N Wijeysundera, Terrence M Yau, Jeannie L Callum, Davy C Cheng, Mark Crowther, Jean-Yves Dupuis, Stephen E Fremes, Blaine Kent, Claude Laflamme, Andre Lamy, Jean-Francois Legare, C David Mazer, Stuart A McCluskey, Fraser D Rubens, Corey Sawchuk, W Scott Beattie
• Journal: Circulation (Circulation) Vol. 119 Issue 4 Pg. 495-502 (Feb 03 2009) ISSN: 1524-4539 [Electronic] United States
• PMID: 19153273 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Anemia (mortality)
• Cardiac Surgical Procedures (adverse effects, statistics & numerical data)
• Cardiopulmonary Bypass (adverse effects, statistics & numerical data)
• Cardiovascular Diseases (epidemiology, surgery)
• Erythrocyte Transfusion (statistics & numerical data)
• Female
• Humans
• Kidney Diseases (etiology, mortality)
• Length of Stay (statistics & numerical data)
• Logistic Models
• Male
• Middle Aged
• Postoperative Complications (mortality)
• Predictive Value of Tests
• Prognosis
• Reoperation (statistics & numerical data)
• Retrospective Studies
• Risk Factors