Acute Kidney Injury (AKI) After Cardiac Surgery: Incidence, Risk Factors and Outcome

Title: Acute Kidney Injury (AKI) After Cardiac Surgery: Incidence, Risk Factors and Outcome

Authors: Lakshminarayana GR, Sheetal LG, Rajesh R, Anil M, George K, Shiv KN, Unni VN

DOI: http://dx.doi.org/10.18535/jmscr/v4i6.10

Abstract

Background: Acute kidney injury (AKI) occurs in up to 30% of patients who undergo cardiac surgery and is associated with substantial morbidity and mortality. There is very limited data regarding the post cardiac surgery AKI from India.

Materials and methods: All consecutive patients who underwent cardiac surgeries at Amrita Institute of Medical Sciences and Research, Kochi, Kerala, from May 2008 to April 2010 were included in the study. Postoperative AKI was defined as >25% change in serum creatinine corresponding to a 20% reduction in Cockroft-Gault GFR from baseline within one week after surgery.

Results: 1146 (males:952; females:194) patients, aged 18-82 years (mean 55.90; SD:11.15) were included in the study. The nature of surgeries and patient number were; CABG (on pump:841, off pump: 73), CABG with valve surgery (32), valve surgery (158) and ASD repair (42) respectively. The overall incidence of AKI was 25.7 % & incidence was highest (53.1 %) in combined CABG with valve surgery and lowest (4.8 %) in ASD repair. Dialysis requiring AKI (AKI-D) was seen 2.1 % of all patients & was highest following (6.25 %) in combined CABG and valve surgeries and none required dialysis after ASD repair. The overall in hospital mortality rate in study was 2.2 % and was highest (50 %) in those with AKI-D.

Conclusions: Cardiac surgery is associated with a high risk for AKI. The incidence of AKI and AKI-D was 25.7 and 2.1%, respectively. Presence of AKI, increased the morbidity and mortality, especially in those with AKI-D.

Keywords: AKI, AKI-D, cardiac surgery

References

1. Conlon PJ, Stafford-Smith M, White WD, et al: Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999; 14: 1158–1162.

2. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT: Renal dysfunction after myocardial revascularization: Risk factors, adverse outcomes and hospital resource utilization. Ann Intern Med 1998; 128: 194–203.

3. Mangos GJ, Brown MA, Chan YA, Horton D, Trew P, Whitworth JA: Acute renal failure following cardiac surgery: Incidence, outcomes and risk factors. Aust N Z J Med 1995; 25: 284–289.

4. Hilberman M, Myers BD, Carrie BJ, Derby G, Jamison RL, Stinson EB: Acute renal failure following cardiac surgery. J Thorac Cardiovasc Surg 1979; 77: 880–888.

5. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J: Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998; 104: 343–348.

6. Kodhandapani C, Jayapal Reddy D, Srinivasa Rao PVLN, Sivakumar V: Acute renal following open heart surgery. Indian Journal of Nephrology 2006; 16: 54 – 57.

7. Sajja LR, Mannam G, Chakravarthi RM, et al. Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non–dialysis dependent renal insufficiency: A randomized study. J Thorac Cardiovasc Surg 2007; 133:378-388

8. Lassnigg A, Schmidlin D, Mouhieddine M, et al: Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: A prospective cohort study. J Am Soc Nephrol 2004; 15: 1597–1605.

9. Loef BG, Epema AH, Smilde TB, et al: Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 2005; 16: 195–200.

10. Abraham VS, Swain JA. Cardiopulmonary bypass and the kidney. In: Cardiopulmonary Bypass: Principles and Practice, 2nd Ed., edited by Gravlee GP, Davis RF, Kurusz M, Utley JR, Philadelphia, Lippincott Williams & Wilkins, 2000: 382–391.

11. Grayson AD, Khater M, Jackson M, Fox MA: Valvular heart operation is an independent risk factor for acute renal failure. Ann Thorac Surg 2003; 75: 1829–1835.

12. Liano F, Pascual J: Epidemiology of acute renal failure: A prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996; 50: 811–818.

13. Chertow GM, Lazarus JM, Christiansen CL, et al: Preoperative renal risk stratification. Circulation 1997; 95: 878–884.

14. Frost L, Pedersen RS, Lund O, Hansen OK, Hansen HE: Prognosis and risk factors in acute, dialysis-requiring renal failure after open-heart surgery. Scand J Thorac Cardiovasc Surg 1991; 25: 161–166.

15. Thakar CV, Liangos O, Yared JP, et al: ARF after open-heart surgery: Influence of gender and race. Am J Kidney Dis 2003; 41: 742–751.

16. Slogoff S, Reul GJ, Keats AS, et al.: Role of perfusion pressure and flow in major organ dysfunction after cardiopulmonary bypass. Ann Thorac Surg 1990; 50: 911–918.

17. Tuttle KR, Worrall NK, Dahlstrom LR, Nandagopal R, Kausz AT, Davis CL: Predictors of ARF after cardiac surgical procedures. Am J Kidney Dis 2003; 41: 76–83.

18. Fischer UM, Weissenberger WK, Warters RD, Geissler HJ, Allen SJ, Mehlhorn U: Impact of cardiopulmonary bypass management on postcardiac surgery renal function. Perfusion 2002; 17: 401–406.

19. Magee MJ, Edgerton JR: Beating heart coronary artery bypass: Operative strategy and technique. Semin Thorac Cardiovasc Surg 2003;15: 83–91.

20. Loef BG, Epema AH, Navis G, Ebels T, van Oeveren W, Henning RH: Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization. Chest 2002; 121: 1190–1194.

21. Ascione R, Lloyd CT, Underwood, Gomes WJ, Angelini GD: On-pump versus off-pump coronary revascularization: Evaluation of renal function. Ann Thorac Surg 1999; 68: 493–498.

22. Schwann NM, Horrow JC, Strong MD, Chamchad D, Guerraty A, Wechsler AS: Does off-pump coronary artery bypass reduce the incidence of clinically evident renal dysfunction after multivessel myocardial revascularization? Anesth Analg 2004; 99: 959–964.

23. Beauford RB, Saunders CR, Niemeier LA, et al: Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency? Heart Surg Forum 2004; 7: E141–146.

24. Gamboso MG, Phillips-Bute B, Landolfo KP, Newman MF, Stafford-Smith M: Off-pump versus on-pump coronary artery bypass surgery and post-operative renal dysfunction. Anesth Analg 2000; 91: 1080–1084.

25. Park M, Shlipak MG, Thiessen-Philbrook H et al. Association of peak changes in Plasma Cystatin C and Creatinine with death after cardiac operations. Ann Thorac Surg 2016; 101 (4): 1395-1401.

26. Chirag RP, Prasad D, Michel Z, et al. Postoperative biomarkers predict AKI and poor outcomes after pediatric cardiac surgery. J Am Soc Nephrol. 2011 Sep; 22(9): 1737–1747.

27. Julie H, Navdeep T, Paul K, et al. Urinary, plasma, and serum biomarkers’ utility for predicting acute kidney injury associated with cardiac surgery in adults: A meta-analysis. American Journal of Kidney Diseases 2015; 66 (6): 993-1005.

28. Alexander Z, Melanie M, Hugo VA, et al. Urinary hyaluronic acid as an early predictor of acute kidney injury after cardiac surgery. J Am Coll Cardiol. 2014;64(7):737-738.

Corresponding Author

Dr Lakshminarayana GR

Consultant Nephrologist, Department of Nephrology, EMS Memorial Cooperative Hospital and Research Centre, Perinthalmanna, Malappuram, Kerala, India-679322

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone: (+91)9495161833