FREQUENCY RISK FACTORS AND OUTCOMES ACUTE KIDNEY INJURY IN THE EARLY PERIOD IN PATIENTS WITH CHRONIC KIDNEY DISEASE AFTER CABG SURGERY

AIM: To evaluate risk factors and prevalence of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) in the early period after isolated coronary artery bypass graft (CABG).

PATIENTS AND METHODS: The study included 830 patients with  isolated CABG. All surgeries were performed in 2016. To evaluate  kidney function in preoperative period glomerular filtration rate  (GFR) was estimated by Chronic Kidney Disease Epidemiology  Collaboration (CKD-EPI) formula. AKI was diagnosed according to  KDIGO criteria. Patients were stratified into two groups according to  estimated glomerular filtration rate (eGFR).

RESULTS: The prevalence of AKI in patients group without CKD after CABG was 11,5% (n=59), in CKD-AKI group – 12,3% (n=39).  In patients with CKD and after intraoperative inotropic/vasopressor  therapy use of only 2 medicinal drugs of this group the probability of  AKI development increases 11,16 times (OR 11,46; 95% CI 3,47- 37,83; р<0,01). During complete bypass (CB) when haematocrit  decreases on 1% AKI probability increases on 12,36% (OR 0,89; 95% CI 0,81-0,98; р=0,02). The necessity of haemodialisys,  duration of stay in intensive care unit and hospitalization duration  were equal to all groups. AKI-CKD development significantly increases intrahospital mortality (p<0,05). 

CONCLUSIONS: History of CKD increases probability of severe AKI and also mortality in early postoperative period. Revealed risk factors for AKI development are potentially modifiable.

1. Смирнов АВ, Добронравов ВА, Румянцев АШ и др. Национальные рекомендации. острое повреждение почек: основные принципы диагностики, профилактики и терапии. ЧАСТЬ I. Нефрология 2016;20(1):79-104. https://doi.org/10.24884/1561-6274- 2016-20-1-8-15 [Smirnov AV, Dobronravov VA, Rumyantsev ASh et al. National guidelines acute kidney injury: basic principles of diagnosis, prevention and therapy. Part I. Nephrology (Saint-Petersburg). 2016;20(1):79-104. (In Russ.) https://doi.org/10.24884/1561-6274-2016- 20-1-8-15]

2. Смирнов АВ, Добронравов ВА, Румянцев АШ и др. Национальные рекомендации. острое повреждение почек: основные принципы диагностики, профилактики и терапии. Часть II. Нефрология. 2016;20(2):86-100 [Smirnov AV, Dobronravov VA, Rumyantsev ASh et al. National guidelines acute kidney injury: basic principles of diagnosis, prevention and therapy. PART II. Nephrology (Saint-Petersburg). 2016;20(2):86- 100. (In Russ.)]

3. O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Critical Care 2016; 20(1): 187

4. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice 2012; 120 (4):179-184

5. Lagny Marc-Gilbert, Jouret F, Koch JN et al. Incidence and outcomes of acute kidney injury after cardiac surgery using either criteria of the RIFLE classification. BMC nephrology 2015;16(1): 76

6. Mariscalco G, Lorusso R, Dominici C et al. Acute kidney injury: a relevant complication after cardiac surgery. The Annals of thoracic surgery 2011; 92 (4): 1539-1547

7. Еременко АА, Минболатова НМ. Острое почечное повреждение у пациентов с синдромом множественной органной дисфункции в раннем периоде после кардиохирургии. Анестезиология и реаниматология 2014; 60 (5): 38-42. [Eremenko AA, Minbolatova NM. Acute kidney injury in patients with multiple organ dysfunction syndrome in the early period after cardiac surgery. Anesteziologiia i reanimatologiia 2014; 60 (5): 38- 42. (in Russian)]

8. Chertow GM, Burdick E, Honour M et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. Journal of the American Society of Nephrology 2005; 16(11): 3365-3370

9. Yi Q, Li K, Jian Z et al. Risk factors for acute kidney injury after cardiovascular surgery: evidence from 2,157 cases and 49,777 controls-a meta-analysis. Cardiorenal medicine 2016; 6(3): 237-250

10. Waikar SS, Curhan GC, Wald R et al. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol 2006;17(4):1143–1150

11. Prescott GJ, Metcalfe W, Baharani J et al. A prospective national study of acute renal failure treated with RRT: incidence, aetiology and outcomes. Nephrol Dial Transplant 2007; 22(9):2513–2519

12. Khosla N, Soroko SB, Chertow GM et al. Preexisting chronic kidney disease: a potential for improved outcomes from acute kidney injury. Clinical Journal of the American Society of Nephrology 2009; 4(12): 1914-1919

13. Wu VC, Huang TM, Lai CF et al. Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality. Kidney Int 2011;80 (11):1222–1230

14. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013 Jan; 3(1):1-150

15. Li SY, Chen JY, Yang WC et al. Acute kidney injury network classification predicts in- hospital and long-term mortality in patients undergoing elective coronary artery bypass grafting surgery. European Journal of Cardio-Thoracic Surgery 2011; 39(3): 323-328

16. Lombardi R, Ferreiro A. Risk factors profile for acute kidney injury after cardiac surgery is different according to the level of baseline renal function. Renal failure 2008; 30(2): 155-160

17. Cartin-Ceba R, Kashiouris M, Plataki M et al. Risk factors for development of acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies. Critical care research and practice 2012

18. Habib RH, Zacharias A, Schwann TA et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? The Journal of Thoracic and Cardiovascular Surgery 125(6): 1438-1450

19. Murphy GS, Hessel EA et al. Optimal perfusion during cardiopulmonary bypass: an evidence-based approach. Anesthesia & Analgesia 2009; 108(5): 1394-1417

20. Ferraris VA, Ferraris SP, Saha SP et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. The Annals of thoracic surgery 2007; 83(5): S27-S86

21. Weerasinghe A, Hornick P, Smith P et al. Coronary artery bypass grafting in non–dialysis- dependent mild-to-moderate renal dysfunction. The Journal of Thoracic and Cardiovascular Surgery 2001; 121(6): 1083-1089

22. Zakeri R, Freemantle N, Barnett V et al. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation 2005; 112(9): I-270

23. Litmathe J, Kurt M, Feindt P et al The impact of pre-and postoperative renal dysfunction on outcome of patients undergoing coronary artery bypass grafting (CABG). The Thoracic and cardiovascular surgeon 2009; 57(08): 460-463