Title: Utility of Preoperative Risk Scoring to Predict Acute Kidney Injury (AKI) Following Cardiac Surgery
Authors: Lakshminarayana GR, Sheetal LG, Rajesh R, Anil M, George K, Shiv KN, Unni VN
DOI: http://dx.doi.org/10.18535/jmscr/v4i6.16
Acute kidney injury (AKI) is known to affect up to 30% of patients whoundergo cardiacsurgeries (CS). This study was done to estimate the incidence of AKI and AKI-D (AKI requiring dialysis) after CS and analyze the effectiveness of pre-operative scoring. All consecutive patients (1146, Males:952; Females:194), aged 18-82 years (Mean 55.90; SD:11.15) who underwent CS at AIMS, Kochi, Kerala, from May 2008 to April 2010 were included in the study. PostoperativeAKI was defined as >25% change in serum creatinine correspondingto a 20% reduction in Cockroft-Gault GFR from baseline withinone week after surgery. The overall incidence of AKI, AKI-D and mortality rate were 25.7, 2.1 and 2.18% respectively. The AKI risk categorization was done by using Cleveland Clinic Foundation score for CS. The frequency of AKI and AKI-D ranged between 13.05 to 92% and 0.24 to 28 %; in low to high risk categories of patients. The need for prolonged hospital stays (> 10 days) and mortality rates ranged between 38.18 to 64% and 0.49 to 20%, respectively, from low to high risk score categories. In multivariate analysis, gender, presence of COPD did not have significant effect and age >40 had a significant effect on AKI. In conclusion, AKI risk score correlated incidence rates of AKI, AKI-D, prolonged hospital stays and mortality. This study validates the ARF risk scoring system by Cleveland Clinic Foundation for the Indian population.We propose a modified risk scoring system for AKI, by including relevant parameters with statistical significance. Key words: AKI, AKI-D, cardiac surgery, risk scoring 1. Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, Landolfo K: Acute renal failure following cardiacsurgery. 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. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J: Independent association between acute renal failure and mortality following cardiacsurgery. Am J Med 1998; 104: 343–348. 4. Anandh U, Rajkumar J, Shetty D. Acute renal failure following cardiac surgery: factors predicting mortality andshort term renal prognosis. Indian J Nephrol 2005;15: Supplement 2: S7-S9 5. Lokeswara RS, Gopichand M, Rajasekara MC, Sriramulu S, Shanti KN, Bhupat-hiraju S, 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 6. Gude D, Jha R. Acute kidney injury following cardiac surgery. Ann Card Anaesth 2012; 15:279-86. 7. Fayaz AR, Saleem MN, Hilal AM, Ahangar AG, Hilal MB, Imtiyaz AW. Profile of Acute Kidney Injury after Open Heart Surgeries in a Tertiary Care Hospital. Saudi J Kidney Dis Transpl 2015;26(6):1177-1182. 8. Mahaldar AR, Sampathkumar K, Raghuram AR, Kumar S, Ramakrishnan M, Mahaldar D. Risk prediction of acute kidney injury in cardiac surgery and prevention using aminophylline. Indian J Nephrol 2012; 22:179-83. 9. Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP: A clinical score to predict acute renal failure after cardiacsurgery. J Am SocNephrol 2005; 16: 162–168. 10. Chertow GM: Preoperative renal risk stratification. Circulation 1997; 95: 878–884. 11. Rajendra HM, Joshua DG, Sean O’Brien, Charles RB, James SG, Constance KH, et al. Bedside Tool for Predicting the Risk of Postoperative Dialysis in Patients Undergoing Cardiac Surgery. Circulation. 2006; 114:2208-2216 12. Wijeysundera DN, Karkouti KM, Dupuis JY, Rao VM,Chan CT, Granton JT, Beattie WS: Derivation and validationof a simplified predictive index for renal replacementtherapy after cardiac surgery. JAMA 2007;297: 1801–1809. 13. Palomba H, de Castro I, Neto AL, Lage S, Yu L: Acutekidney injury prediction following elective cardiac surgery:AKICS score. Kidney Int. 2007; 72: 624–631. 14. Loef BG, Epema AH, Smilde TB, Henning RH, Ebels T, Navis G, Stegeman CA: Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am SocNephrol 2005; 16: 195–200. 15. Abraham VS, Swain JA. Cardiopulmonary bypass and the kidney. In: Cardiopulmon-ary Bypass: Principles and Practice, 2nd Ed., edited by Gravlee GP, Davis RF, Kurusz M, Utley JR, Philadelphia, Lippin-cott Williams & Wilkins, 2000: 382–391. 16. Grayson AD, Khater M, Jackson M, Fox MA: Valvular heart operation is an independent risk factor for acute renal failure. Ann ThoracSurg 2003; 75: 1829–1835. 17. Angel CT, Elena EM, Victor A, Marıa TT, Diego P, Angelica de P, et al. Predicting Acute Renal Failure after Cardiac Surgery: External Validation of Two New Clinical Scores. Clin J Am SocNephrol2008; 3: 1260–1265. Abstract
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