COMPLETE MODEL STEWART-FIGGE-FENCL IN OUTCOMES PREDICTING IN CARDIAC SURGERY PATIENTS WITH ACUTE KIDNEY INJURY TREATED BY CONTINUOUS RENAL REPLACEMENT THERAPY

THE AIM: to evaluate the full model Stewart-Figge-Fencl parameters information value in adult cardiac patients with acute kidney injury (AKI) receiving continuous renal replacement therapy (RRT) and their suitability for stratification of adverse renal outcomes risk. PATIENTS AND METHODS: A retrospective cohort study was performed in 161 cardiac surgery patients from 21 to 80 years with dialysis-dependent AKI treated with continuous RRT. The parameters of a full model Stewart-Figge-Fencl including anion gap (Anion Gap), apparent and effective strong ion difference (Strong Ion Difference, «apparent», «effective») and strong ion gap (SIG) were analyzed. Using ROC- analysis, unmeasured ions were investigated as potential significant predictor's of in-hospital mortality and requirement for intermittent RRT after the continuous method termination. RESULTS. It was found that adult cardiac surgery patients with AKI characterized by the development of latent metabolic acidosis with increased anion gap, with a consequent reduction unmeasured ions for 2 days on background CRRT Specific patterns in the dynamics of unmeasured ions common to survivors and dead patients with AKI were detected. CONCLUSION: The appropriate and timely correction of unmeasured ions in patients with AKI, not only can improve a short-term but also long-term prognosis through reducing the need for intermittent renal replacement therapy after continuous RRT

acute kidney injury, unmeasured ions, prognosis, cardiac surgery, model Stewart-Figge-Fencl, continuous renal replacement therapy

1. Thakar CV. Perioperative acute kidney injury. Adv Chronic Kidney Dis 2013;20(1):67-75

2. Claure-Del Granado R, Bouchard J. Acid-base and electrolyte abnormalities during renal support for acute kidney injury: recognition and management. Blood Purif 2012;34(2):186-193

3. Колесников СВ, Борисов СВ. Острое почечное повреждение: новые аспекты известной проблемы. Патология кровообращения и кардиохирургия 2013;4:69-73

4. Смирнов АВ, Каюков ИГ, Добронравов ВА, Румянцев АШ. Острое повреждение почек: концептуальные проблемы. Нефрология 2014; 18(2): 8-24

5. Kellum JA. Acid-base disorders and strong ion gap. Contrib Nephrol 2007;156:158-166

6. Kneidinger N, Funk GC, Lindner G et al. Unmeasured anions are associated with short-term mortality in patients with hypoxic hepatitis. Wien Klin Wochenschr 2013;125(15-16):474-480

7. Stewart P. Modern quantitative acid-base chemistry. Can J Physiol Pharmacol 1983;61:1444-1461

8. Figge J, Rossing TH, Fencl V. The role of serum proteins in acid-base equilibria. J Lab Clin Med 1991;117:453-67

9. Lautrette A, Fejjal M, Aithssain A et al. Comparison of three methods of diagnosis of plasma unmeasured anions in critically ill patients. Minerva Anestesiol 2013;79(10):1164-1172

10. Moviat M, van den Boogaard M, Intven F et al. Crit Care 2013;28(6):1048-1054

11. Zampieri FG, Park M, Ranzani OT et al. Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study. Rev Bras TerIntensiva 2013;25(3):205-211

12. Gatz R. Strong ion gap in cardiogenic shock-the calculation seems wrong. Acute Card Care 2014; PMID: 24410273

13. Berndtson AE, Palmieri TL, Greenhalgh DG, Sen S. Strong ion difference and gap predict outcomes after adult burn injury. J Trauma Acute Care Surg 2013;75(4):555-560

14. Румянцев АШ. Особенности врачебной тактики при лечении преренальной острой почечной недостаточности. Нефрология 2005; 9 (1): 98-100

15. Thakar CV, Worley S, Arrigain S, et al. Improved survival in acute kidney injury after cardiac surgery. Am J Kidney Dis 2007;50(5):703-711

16. Смирнов АВ, Каюков ИГ, Дегтерева ОА и др. Проблемы диагностики и стратификации тяжести острого повреждения почек. Нефрология 2009; 13 (3): 9-18

17. Agrafiotis M, Sileli M, Ampatzidou F, et al. The base excess gap is not a valid tool for the quantification of unmeasured ions in cardiac surgical patients: a retrospective observational study. Eur J Anaesthesiol 2013;30(11):678-684

18. Morimatsu H, Toda X, Egi M, et al. Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit. J Anesth 2009;23(3):334-340

19. Attanà P, Lazzeri C, Chiostri M, et al. Strong-ion gap approach in patients with cardiogenic shock following ST-elevation myocardial infarction. Acute Card Care 2013;15(3):58-62

20. Bellomo R, Ronco C, Kellum JA et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI). Group Crit Care 2004; 8(4):204-212

21. Смирнов АВ, Добронравов ВА, Каюков ИГ и др. Хроническая болезнь почек: дальнейшее развитие концепции и классификации. Нефрология 2007;11(4):7-17

22. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int 2012;82(5):516-524

23. Колесников СВ, Борисов СВ. Нелинейный метод прогнозирования неблагоприятных ренальных исходов у пожилых кардиохирургических пациентов. Нефрология 2013;(4):77-82

24. Palevsky PM, Zhang JH, O’Connor TZ et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008; 359(1):7-20