The Perioperative Hyperchloremia Is Associated With Postoperative Acute Kidney Injury in Patients With off-Pump Coronary Artery Bypass Grafting: A Retrospective Study
Hyperchloremia is Associated with Postoperative Acute Kidney Injury
DOI:
https://doi.org/10.1532/hsf.3443Keywords:
acute kidney injury, coronary artery bypass surgery, hyperchloremia, propensity score matchingAbstract
Background: The relationship between perioperative hyperchloremia and postoperative acute kidney injury (AKI) is not well established. Our study aimed to evaluate the association between perioperative hyperchloremia and acute kidney injury in patients undergoing off-pump coronary artery bypass grafting (CABG).
Methods: Patients with coronary disease who underwent off-pump CABG between April 2017 and
December 2019 were enrolled in this retrospective study. The patients with perioperative hyperchloremia were matched 1:1 to patients without perioperative hyperchloremia. The primary outcome was the postoperative acute kidney injury rate. The secondary outcomes included intensive care unit (ICU)-free days, postoperative hospitalization days, wound infection rate, and in-hospital mortality. Propensity score matching and univariate and multivariate logistic regression analyses were used in
this study.
Results: A total of 321 patients who underwent off-pump CABG were included in the analysis. Propensity score matching selected 83 pairs for the final comparison. The results showed that the postoperative AKI rate was significantly different between the hyperchloremia and no hyperchloremia groups (56.6% versus 15.7%; P < .001). The number of ICU-free days, postoperative hospitalization days, wound infection rate, and in-hospital mortality were similar between the two groups. In the multivariable, logistic regression analysis, hyperchloremia was independently associated with the development of postoperative AKI (odds ratio [OR] = 1.814, 95% confidence interval [CI]: 1.072-3.070,
P = .026).
Conclusions: Perioperative hyperchloremia is associated with an increase in the postoperative AKI rate among patients undergoing off-pump CABG.
References
Chen SW, Chang CH, Fan PC, et al., 2016. Comparison of contemporary preoperative risk models at predicting acute kidney injury after isolated coronary artery bypass grafting: a retrospective cohort study. BMJ Open 6: e010176.
Chou YH, Huang TM, Wu VC, et al. 2019. Associations between preoperative continuation of renin-angiotensin system inhibitor and cardiac surgery-associated acute kidney injury: a propensity score-matching analysis. J Nephrol 32: 957-966.
Chowdhury AH, Cox EF, Francis ST, Lobo DN. 2012. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte(R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 256: 18-24.
Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA. 2008. Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol Dial Transplant 23: 1970-4.
de Vasconcellos K, Skinner DL. 2018. Hyperchloraemia is associated with acute kidney injury and mortality in the critically ill: A retrospective observational study in a multidisciplinary intensive care unit. J Crit Care 45: 45-51.
Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, et al. 2015. Cost and Mortality Associated With Postoperative Acute Kidney Injury. Ann Surg 261: 1207-14.
Hobson CE, Yavas S, Segal MS, et al. 2009. Acute Kidney Injury Is Associated With Increased Long-Term Mortality After Cardiothoracic Surgery. Circulation 119: 2444-2453.
Kimura S, Iwasaki T, Shimizu K, et al. 2019. Hyperchloremia Is Not an Independent Risk Factor for Postoperative Acute Kidney Injury in Pediatric Cardiac Patients. J Cardiothorac Vasc Anesth 33: 1939-1945.
Korenkevych D, Ozrazgat-Baslanti T, Thottakkara P, et al. 2016. The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery. Ann Surg 263: 1219-1227.
Kumar AB, Suneja M. 2011. Cardiopulmonary Bypass–associated Acute Kidney Injury. Anesthesiology: The Journal of the American Society of Anesthesiologists 114: 964-970.
Lomivorotov V, Fominskiy E, Efremov S, et al. 2014. Infusion of 7.2% NaCl/6% Hydroxyethyl Starch 200/0.5 in On-Pump Coronary Artery Bypass Surgery Patients: A Randomized, Single-Blind Pilot Study. Shock (Augusta, Ga.) 41: 193-9.
Marttinen M, Wilkman E, Petaja L, Suojaranta-Ylinen R, Pettila V, Vaara ST. 2016. Association of plasma chloride values with acute kidney injury in the critically ill - a prospective observational study. Acta Anaesthesiol Scand 60: 790-9.
McIlroy DR, Argenziano M, Farkas D, Umann T, Sladen RN. 2013. Incorporating Oliguria Into the Diagnostic Criteria for Acute Kidney Injury After On-Pump Cardiac Surgery: Impact on Incidence and Outcomes. Journal of Cardiothoracic and Vascular Anesthesia 27: 1145-1152.
McIlroy D, Murphy D, Kasza J, Bhatia D, Wutzlhofer L, Marasco S. 2017. Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial. Intensive Care Med 43: 795-806.
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.
Nadeem A, Salahuddin N, El Hazmi A, et al. 2014. Chloride-liberal fluids are associated with acute kidney injury after liver transplantation. Crit Care 18: 625.
Oh TK, Do SH, Jeon YT, Kim J, Na HS, Hwang JW. 2019. Association of Preoperative Serum Chloride Levels With Mortality and Morbidity After Noncardiac Surgery. Anesthesia & Analgesia 129: 1494-1501.
Oh TK, Kim CY, Jeon YT, Hwang JW, Do SH. 2019. Perioperative Hyperchloremia and its Association With Postoperative Acute Kidney Injury After Craniotomy for Primary Brain Tumor Resection: A Retrospective, Observational Study. J Neurosurg Anesthesiol 31: 311-317.
Oh TK, Song IA, Kim SJ, et al. 2018. Hyperchloremia and postoperative acute kidney injury: a retrospective analysis of data from the surgical intensive care unit. Crit Care 22: 277.
Suetrong B, Pisitsak C, Boyd JH, Russell JA, Walley KR. 2016. Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients. Crit Care 20: 315.
Vives M, Wijeysundera D, Marczin N, Monedero P, Rao V. 2014. Cardiac surgery-associated acute kidney injury. Interact Cardiovasc Thorac Surg 18: 637-45.
Yunos NM, Bellomo R, Story D, Kellum J. 2010. Bench-to-bedside review: Chloride in critical illness. Crit Care 14: 226.
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