Pre-operative and peri operative predictors of acute renal failure after cardiac surgery
DOI:
https://doi.org/10.18203/2349-3933.ijam20192112Keywords:
Acute renal failure, Cardiac surgery, Cardiopulmonary bypass, Open heart surgery, OutcomeAbstract
Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.
Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.
Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.
Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.
References
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365-70.
Chertow GM, Lazarus JM, Christiansen CL, Cook EF, Hammermeister KE, Grover F, et al. Preoperative renal risk stratification. Circulation. 1997;95(4):878-84.
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. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med. 1998;128(3):194-203.
Thakar CV, Liangos O, Yared JP, Nelson D, Piedmonte MR, Hariachar S, et al. ARF after open-heart surgery: Influence of gender and race. Am J Kidney Dis. 2003;41(4):742-51.
Thakar CV, Yared JP, Worley S, Cotman K, Paganini EP. Renal dysfunction and serious infections after open-heart surgery. Kidney Int. 2003;64(1):239-46.
Fortescue EB, Bates DW, Chertow GM. Predicting acute renal failure after coronary bypass surgery: cross-validation of two risk-stratification algorithms. Kidney Int. 2000;57(6):2594-602.
Mehta RH, Grab JD, O'Brien SM, Bridges CR, Gammie JS, Haan CK, et al. Society of Thoracic Surgeons National Cardiac Surgery Database Investigators. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation. 2006;114(21):2208-16.
Aronson S, Fontes ML, Miao Y, Mangano DT. Investigators of the Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. Risk index for perioperative renal dysfunction/failure: critical dependence on pulse pressure hypertension. Circulation 2007;115(6):733-42.
Hutchens MP, Dunlap J, Hurn PD, Jarnberg PO. Renal ischemia: does sex matter? Anesth Analg. 2008;107(1):239-49.
Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg. 1998;66(1):125-31.
Hogue CW Jr, Barzilai B, Pieper KS, Coombs LP, DeLong ER, Kouchoukos NT, et al. Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report. Circulation. 2001;103(17):2133-7.
Koch CG, Weng YS, Zhou SX, Savino JS, Mathew JP, Hsu PH, et al. Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. Prevalence of risk factors, and not gender per se, determines short- and long-term survival after coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2003;17(5):585-93.
Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16(1):162-8.
Wijeysundera DN, Karkouti K, Dupuis JY, Rao V, Chan CT, Granton JT, et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA. 2007;297(16):1801-9.
Rahmanian PB, Kwiecien G, Langebartels G, Madershahian N, Wittwer T, Wahlers T. Logistic risk model predicting postoperative renal failure requiring dialysis in cardiac surgery patients. European J Cardio-thoracic Surg. 2011;40(3):701-9.
Lohr JW, McFarlane MJ, Grantham JJ. A clinical index to predict survival in acute renal failure patients requiring dialysis. Am J Kidney Dis. 1988; 11(3):254-9.
Lien J, Chan V. Risk Factors Influencing Survival in Acute Renal Failure Treated by Hemodialysis. Arch Intern Med 1985;145(11):2067-9.
Brown JR, Cochran RP, Leavitt BJ, Dacey LJ, Ross CS, et al. Northern New England Cardiovascular Disease Study Group. Multivariable prediction of renal insufficiency developing after cardiac surgery. Circulation. 2007 Sep 11;116(11 Suppl):I139-43.
Palomba H, de Castro I, Neto AL, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney Int. 2007;72(5):624-31.
Boldt J, Brenner T, Lehmann A, Suttner SW, Kumle B, Isgro F. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg. 2003;75(3):906-12.
Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, et al. Acute renal failure following cardiac surgery. Nephrol Dial Transplant. 1999;14(5):1158-62.
Eriksen BO, Hoff KR, Solberg, S. Prediction of acute renal failure after cardiac surgery: retrospective cross-validation of a clinical algorithm. Nephrol Dial Transplant. 2003;18:77-81.
Messmer K. Hemodilution. Surg. Clin North Am 1975;55(3):659-78.
Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg. 2003;125(6):1438-50.
Swaminathan M, Phillips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M. The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Ann Thorac Surg. 2003;76(3):784-91.
von Heymann C, Sander M, Foer A, Heinemann A, Spiess B, Braun J, et al. The impact of an hematocrit of 20% during normothermic cardiopulmonary bypass for elective low risk coronary artery bypass graft surgery on oxygen delivery and clinical outcome--a randomized controlled study. Crit Care. 2006;10(2):R58.
Stafford-Smith M, Newman MF. What effects do hemodilution and blood transfusion during cardiopulmonary bypass have on renal outcomes? Nat Clin Pract Nephrol. 2006;2(4):188-9.
Garella S, Matarese RA. Renal effects of prostaglandins and clinical adverse effects of nonsteroidal anti-inflammatory agents. Medicine (Baltimore). 1984;63(3):165-81.
Hock R, Anderson RJ. Prevention of drug-induced nephrotoxicity in the intensive care unit. J Crit Care. 1995;10(1):33-43.
Lopes JA, Fernandes P, Jorge S, Gonçalves S, Alvarez A, Costa e Silva Z, et al. Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care. 2008;12(4):R110.
