Preoperative Urinary pH is Associated with Acute Kidney Injury After Cardiac Surgery in Non-Diabetic Patients
DOI:
https://doi.org/10.1532/hsf.2509Abstract
Background: Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The present study aims to analyze the association of preoperative urinary pH with acute kidney injury after isolated coronary artery bypass graft surgery (CABG).
Methods: We retrospectively reviewed the data of 270 adult non-diabetic patients who underwent isolated CABG surgery with normal renal function. The perioperative data of the patients included demographic data, laboratory findings, morbidity, and mortality. The patient population was divided into four groups: Group I, patients with preoperative urinary pH=5; Group II, patients with preoperative urinary pH=5.5; Group III, patients with preoperative urinary pH=6-6.5; and Group IV, patients with preoperative urinary pH ≥ 7.0. Kidney injury was interpreted according to the Kidney Disease: Improving Global Outcomes (KDIGO).
Results: There were 108 patients (40%) in Group I, 44 patients (16.3%) in Group II, 78 patients (28.9%) in Group III, and 40 patients (14.8%) in Group IV. Postoperative acute kidney injury (AKI) occurred in 39 patients (36.1%) in Group I, 4 patients (9.1%) in Group II, and 2 patients (2,5%) in Group III. None of the patients developed AKI in Group IV. Renal replacement therapy was required in 8 patients (2.3%) (6 patients from Group I; 2 patients from Group II; P = .016). Thirty-day mortality occurred in 5 patients (1.9%) (5 patients from Group I; none from other groups; P = .017). All of the patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower pH levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 0.193; 95% CI: 0.103-0.361; P < .001).
Conclusion: Low preoperative urinary pH (≤5.5) results in severe acute kidney injury and increases the rate of morbidity and mortality after isolated CABG.
References
Albert C, Albert A, Kube J, et al. 2018. Urinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery. J Thorac Cardiovasc Surg 155:2441-2452.
Bailey M, McGuinness S, Haase M, Haase-Fielitz A, Parke R, Hodgson CL, et al. 2015. Sodium Bicarbonate and Renal Function after Cardiac Surgery: A Prospectively Planned Individual Patient Meta-analysis. Anesthesiology. 122:294–306.
Chung SM, Moon JS, Yoon JS, Won KC, Lee HW. 2018. Low urine pH affects the development of metabolic syndrome, associative with the increase of dyslipidemia and dysglycemia: Nationwide cross-sectional study (KNHANES 2013-2015) and a single-center retrospective cohort study. PLoS One. 13(8):e0202757.
Cockcroft DW, Gault MH. 1976. Prediction of creatinine clearance from serum creatinine. Nephron 16:31-41.
Doddakula K, Al-Sarraf N, Gately K, et al. 2007. Predictors of acute renal failure requiring renal replacement therapy post cardiac surgery in patients with preoperatively normal renal function. Interact Cardiovasc and Thorac Surg 6:314-18.
Dong Y, ZhangB, Liang L, Lian Z, Liu J, Liang C, Zhang S. 2016. How Strong Is the Evidence for Sodium Bicarbonate to Prevent Contrast-Induced Acute Kidney Injury After Coronary Angiography and Percutaneous Coronary Intervention? Medicine (Baltimore); 95:e2715.
Findik O, Aydin U, Baris O, Parlar H, Alagoz GA, Ata Y, Turk T, Kunt AT. 2016. Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery. Heart Surg Forum. 19: E123-7.
Haase M, Haase-Fielitz A, Bagshaw SM, Ronco C, Bellomo R. 2007. Cardiopulmonary bypass-associated acute kidney injury: a pigment nephropathy? Contrib Nephrol 156:340-353.
Haase M, Haase-Fielitz A, Plass M, et al. 2013. Prophylactic Perioperative Sodium Bicarbonate to Prevent Acute Kidney Injury Following Open Heart Surgery: A Multicenter Double-Blinded Randomized Controlled Trial. PLoS Med. 10:e1001426.
Heringlake M, Heinze H, Schubert M, et al. 2012. A perioperative infusion of sodium bicarbonate does not improve renal function in cardiac surgery patients: a prospective observational cohort study.Critical Care 16: R156.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. 2012. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2: 1–138.
Kocogulları CU, Kunt AT, Aksoy R, Duzyol C, Parlar H, Saskın H, Fındık O. 2017. Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients. Braz J Cardiovasc Surg. 32:83-89.
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, Bachmann LM, Druml W, Bauer P, Hiesmayr M. 2004. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol :1597-1605.
Loef BG, Epema AH, Navis G, Ebels T, van Oeveren W, Henning RH. 2002. Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization. Chest. 121:1190–4.
Mao H, Katz N, Ariyanon W, Blanca-Martos L, Adýbelli Z, Giuliani A, Danesi TH, Kim JC, Nayak A, Neri M, Virzi GM, Brocca A, Scalzotto E, Salvador L, Ronco C. 2013. Cardiac surgery-associated acute kidney injury.Cardiorenal Med. 3:178-199.
Mirmuhammad-Sadeghi M, Naghiloo A, Najarzadegan MR. 2013. Evaluating the relative frequency and predictors of acute renal failure following coronary artery bypass grafting. ARYA Atheroscler 9:287-92.
Nakanishi N., Fukui M., Tanaka M., Toda H., Imai S., Yamazaki M., et al. 2012. Low urine pH Is a predictor of chronic kidney disease. Kidney Blood Press Res 35:77-81.
O'Neal JB, Shaw AD, Billings FT 2016. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 20:187.
Prowle JR, Calzavacca P, Licari E, et al. 2015. Combination of biomarkers for diagnosis of acute kidney injury after cardiopulmonary bypass. Ren Fail. 37:408-16.
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 9:20-26.
Tekeli Kunt A, Parlar H, Findik O, Duzyol C, Baris O, Balci C. 2016. The Influence of Metabolic Syndrome on Acute Kidney Injury Occurrence after Coronary Artery Bypass Grafting.Heart Surg Forum. 19:E099-103.
Träger K, Fritzler D, Fischer G, Schröder J, Skrabal C, Liebold A, Reinelt H. 2016. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series.Int J Artif Organs. May 16;39(3):141-6.
Uchino S, Kellum JA, Belloma R, et al. 2005. Acute renal failure in critically ill patients; a multinational, multicenter study. JAMA 294:813-818
Weerasinghe A, Hornick P, Smith P, Taylor K, Ratnatunga C. 2001. Coronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction J Thorac Cardiovasc Surg 121:1083-9.
Wetz AJ, Bräuer A, Quintel M, Heise D. 2015. Does sodium bicarbonate infusion really have no effect on the incidence of acute kidney injury after cardiac surgery? A prospective observational trial.Critical Care 19:183-93.
Zager RA, Gamelin LM. 1989. Pathogenetic mechanisms in experimental hemoglobinuric acute renal failure. Am J Physiol 256: F446–F455.
