Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery
AbstractBackground: Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).
Methods: We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels <3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.
Results: There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661;
P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG.
Conclusion: Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.
Abel RM, Buckley MJ, Austen WG, Barnett GO, Bech CH Jr, Fischer JE. 1976. Etiology, incidence and prognosis of renal falure following cardiac surgeries. Results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg 71:323-33.
Ataseven B, duBois A, Reinthaller A, et al. 2015. Preoperative serum albumin is associated with postoperative complication rate and overall survival in patients with epithelial overian cancer undergoing cytoreductive surgery. Gynecol Oncol 138:50-65.
Bhamidipati CM, LaPar DJ, Mehta GS, et al. 2011. Albumin is a better predictor of outcomes than body mass index following coronary artery bypass grafting. Surgery 150:626-34.
Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra DF, Kesecioğlu J. 2002. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure:a prospective, randomized trial. Crit Care Med 30:2205-11.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. 2005. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16:3365-70.
Cockcroft DW, Gault MH. 1976. Prediction of creatinine clearance from serum creatinine. Nephron 16:31-41.
De la Cruz KI, Bakaeen FG, Wang XLO, et al. 2011. Hypoalbuminaemia and long-term survival after coronary artery bypass: a propensity score analysis. Ann Thorac Surg 91:671-6.
Demirkılıç U, Kuralay E, Yenicesu M, et al. 2004. Timing of replacement therapy for acute renal failure after cardiac surgery. J Card Surg 19:17-20.
Elahi MM, Lim MY, Joseph RN, Dhannapuneni RR, Spyt TJ. 2004. Early hemofiltration improves survival in post-cardiotomy patients with acute renal failure. Eur J Cardiothorac Surg 26:1027-31.
Engelman DT, Adams DH, Byrne JG, et al. 1999. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg 118:866-73.
Englberger L, Suri RM, Li Z, et al. 2011. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care 15:R16.
Fanali G, di Masi A, Trezza V, Marino M, Fasano M, Ascenzi P. 2012. 2012. Human serum albumin: from bench to bedside. Mol Aspects Med 33:209-90.
Gabay C, Kushner I. 1999. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 340:448-54.
Gibney RT, Bagshaw SM, Kutsogiannis DJ, Johnston C. 2008. When should renal replacement therapy for acute kidney injury be initiated and discontinued? Blood Perf 26:473-84.
Ha C-E, Bhagavan NV. 2013. Novel insights into the pleotropic effects of serum albumin in health and disease. Biochim Biophys Acta 1830:5486-93.
Iyem H, Tavli M, Akçiçek F, Buket S. 2009. Importance of early dialysis for acute renal failure after an open-heart surgery. Hemodial Int 13:55-61.
Koertzen M, Punjabi P, Lackwood G. 2013. Preoperative serum albumin concentration as a predictor of mortality and morbidity following cardiac surgery. Perfusion 28:390-4.
Kunt AT, Akgün S, Atalan S, Bitir N, Arsan S. 2009. Furosemide infusion prevents the requirement of renal replacement therapy after cardiac surgery. Anadolu Kardiyol Derg 9:499-504.
Lafrance JP, Miller DR. 2010. Acute kidney injury associates with increased long-term mortality. J Am Soc Nephrol 21:345-52.
Lassnigg A, Donner E, Grubhofer G, Presterl E, Druml W, Hiesmayr M. 2000. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 11:97-104.
Lassnigg A, Schmidlin D, Mouhieddine M, et al. 2004. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 15:1597-1605.
Lee EH, Baek SH, Chin JH, et al. 2012. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med 38:1478-86.
Loef BG, Epema AH, Smilde TD, et al. 2005. Immediate postoperative renal function deteriotion in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 16:195-200.
Manche A, Casha A, Rychter J, Farrugia E, Debono M. 2008. Early dialysis in acute kidney injury after cardiac surgery. Interact Cardiovasc Thorac Surg 7:829-32.
Mangano CM, Diamondstone IS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. 1998. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Ann InternMed 128:194-203.
Mao H, Katz N, Ariyanon W, et al. 2013. Cardiac surgery-associated acute kidney injury. Cardiorenal Med 3:178-99.
Mehta RL, Kellum JA, Shah SV, et al. 2007. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31.
Montazerghaem H, Safaie Nezhad V. 2014. Body mass index or serum albumin levels: Which is further prognostic following cardiac surgery? J Cardiovasc Thorac Res 6:123-6.
Rady MY, Ryan T, Starr NJ. 1998. Peri-operative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med 26:225-35.
Rapp-Kesek D, Stahle E, Karlsson TT. 2004. Body mass index and albumin in the pre-operative evaluation of cardiac surgery patients. Clin Nutr 23:1398-404.
Rothschild MA, Oratz M, Schreiber SS. 1998. Serum albumin. Hepatology 8:335-401.
Schopka S, Claudius D, Camboni D, Floerchinger B, Schmid C, Hilker M. 2014. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis. J Cardiothorac Surg 9:20-6.
Sugahara S, Suzuki H. 2004. Early start on continuous hemodialysis therapy improves survival rate in patients with acute renal failure following coronary bypass surgery. Hemodial Int 8:320-5.
Uchino S, Kellum JA, Belloma R, et al. 2005. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813-18.
Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. 2003. Hypoalbuminemia in acute illness; Is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg 237:319-34.
Wedermann CI, Wedermann W, Joannidis M. 2010. Hypoalbuminemia and acute kidney injury:a meta-analysis of observational clinical studies. Intensive Care Med 36:1657-65.
Yap FH, Joynt GM, Buckley TA, Wong EI. 2002. Association of serum albumin concentration and mortality risk in critically ill patients. Anaesth Intensive Care 30:202-7.
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