RISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY IN PATIENTS WITH INTACT RENAL FUNCTION UNDERGOING CORONARY ARTERY BYPASS GRAFTING
https://doi.org/10.24884/1561-6274-2013-17-4-63-67
Abstract
AIM: to study frequency and risk factors of AKI and also features of its clinical course in the postoperative period in patients undergoing CABG in a planned order. PATIENTS AND METHODS. 548 patients (331 men and 217 women) aged from 42 to 68 years (57,9±8,3 years) were examined before and after CABG by cardiopulmonary bypass. A serum creatinine (sCr) levels and glomerular filtration rate were defined before operation, daily within 7 days after CABG, at discharge from the hospital and in 3 months after discharge. AKI was diagnosed and classified by level of sCr using criteria of RIFLE. RESULTS. AKI was diagnosed in 132 patients (24,1%) after CABG, out of them 109 patients (19,9%) had mild AKI, 64 patients (11,7%) – moderate AKI and 29 patients (5,3%) – with severe AKI. Also transient AKI was revealed in 58,3% of the cases, persistent AKI – in 39,4% of the cases and resistant AKI – in 2,3% of the cases. Renal replacement therapy (hemodialysis) was performed in 7 patients (36,8%). An in-hospital mortality among patients with and without AKI was 7,6% and 2,2% respectively (χ2 = 7,23; p = 0,007). CONCLUSION. Thus, sCr levels in patients with AKI were associated with such factors as characteristics of severity of CABG surgery, comorbid conditions such as congestive heart failure, hypertension, atrial fibrillation and age higher than 60 years.
About the Authors
B. G. Iskenderov
Пензенский институт усовершенствования врачей
Russian Federation
Russian Federation
O. N. Sisina
Пензенский институт усовершенствования врачей
Russian Federation
Russian Federation
References
1. Akcay A, Turkmen K, Lee D, Edelstein C. Update on the diagnosis and management of acute kidney injury. Int J Nephrol Renovasc Disc 2010; 3: 129-140
2. Смирнов АВ, Каюков ИГ, Дегтерева ОА и др. Проблемы диагностики и стратификации тяжести острого повреждения почек. Нефрология 2009; 13(3): 9-18
3. Haase M, Bellomo R, Matalanis G et al. A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery-associated acute kidney injury: a prospective cohort study. J Thorac Cardiovasc Surg 2009; 138(6): 1370-1376
4. Cerda J, Lameire N, Eggers P et al. Epidemiology of acute kidney injury. Clin J Am Soc Nephrol 2008; 3: 881-886
5. Waikar SS, Liu KD, Chertow GM. Diagnosis, epidemiology, and outcomes of acute renal failure. Clin J Am Soc Nephrol 2008; 3(3): 844-861
6. Kim MJ, Choi HS, Oh SH. et al. Impact of Acute Kidney Injury on Clinical Outcomes after ST Elevation Acute Myocardial Infarction. Yonsei Med J 2011; 52(4): 603–609
7. Loef BG, Epema AH, Smilde TD 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
8. Hobson CE, Yavas S, Segal MS et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation 2009; 119: 2444-2453
9. Coca SG, Yusuf B, Shlipak MG et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: A systematic review and meta-analysis. Am J Kidney Disc 2009; 53: 961–973
10. Brown JR, Cochran RP, Dacey LJ et al. Perioperative increases in serum creatinine are predictive of increased 90-day mortality after coronary artery bypass graft surgery. Circulation 2006; 114: I409-I413
11. 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(6): 1597-1605
12. Huang TM, Wu VC, Young GH et al. Preoperative proteinuria predicts adverse renal outcomes after coronary artery bypass grafting. J Am Soc Nephrol 2011; 22: 156-163
13. Wijns W, Kolh P, Danchin N et al. Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010; 31(20): 2501-2555
14. Parikh CR, Coca SG, Wang Y et al. Long-term prognosis of acute kidney injury after acute myocardial infarction. Arch Intern Med 2008; 168: 987–995
15. Levey AS, Greene T, Kusek J et al. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 2000; 11: A0828
16. Roques F, Nashef SA, Michel P et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999; 15(6): 816-822
17. Sudarsky D, Nikolsky E. Contrast-induced nephropathy in interventional cardiology. Int J Nephrol Renovasc Disc 2011; 4: 85-99
Review
For citations:
Iskenderov B.G., Sisina O.N. RISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY IN PATIENTS WITH INTACT RENAL FUNCTION UNDERGOING CORONARY ARTERY BYPASS GRAFTING. Nephrology (Saint-Petersburg). 2013;17(4):63-67. (In Russ.) https://doi.org/10.24884/1561-6274-2013-17-4-63-67
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