Acute Kidney Injury: Lessons from Pericardiectomy
Keywords:Acute kidney injury, risk factors, prevention, management, pericardiectomy
Background: Acute kidney (renal) injury (AKI) is a severe and common complication that occurs in ~40% of patients undergoing cardiac surgery. AKI has been associated with increased mortality and worse prognosis. This prospective study was conducted to determine the risk factors for AKI after pericardiectomy and decrease the operative risk of mortality and morbidity.
Methods: This was a prospective, observational cohort study of patients with constrictive pericarditis undergoing pericardiectomy. All patients underwent pericardiectomy via median sternotomy. Serum creatinine was used as the diagnostic standard of AKI according to Kidney Disease
Improving Global Outcomes classification. All survivors were monitored to the end date of the study.
Results: Consecutive patients (N = 92) undergoing pericardiectomy were divided into 2 groups: with AKI (n = 25) and without AKI (n = 67). The incidence of postoperative AKI was 27.2% (25/92). Hemodialysis was required for 10 patients (40%), and there were 5 operative deaths. Mortality, intubation time, time in intensive care unit, fresh-frozen plasma, and packed red cells of the group with AKI were significantly higher than those of the group without AKI. Both univariate and multivariate analyses showed that statistically significant independent predictors of AKI include intubation time, chest drainage, fresh-frozen plasma, and packed red cells. The latest follow-up data showed that 85 survivors were New York Heart Association class I (97.7%) and 2 were
class II (2.3%).
Conclusions: AKI after pericardiectomy is a serious complication and contributes to significantly increased morbidity and mortality. Prevention of AKI development after cardiac surgery and optimization of pre-, peri-, and postoperative factors that can reduce AKI, therefore, contribute to a better postoperative outcome and leads to lower rates of AKI, morbidity, and mortality.
Calderon-Rojas R, Greason KL, King KS, et al. Tricuspid valve regurgitation in patients undergoing pericardiectomy for constrictive pericarditis. Semin Thorac Cardiovasc Surg 2020;32:P721-P728.
Cho JS, Shim JK, Lee S, et al. Chronic progression of cardiac surgery associated acute kidney injury: Intermediary role of acute kidney disease. J Thorac Cardiovasc Surg 2019:161:681-688.e3.
Dedemoğlu M, Tüysüz ME. Risk estimation model for acute kidney injury defined by KDIGO classification after heart valve replacement surgery. Gen Thorac Cardiovasc Surg 2020;68:922-931.
Engelman DT, Crisafi C, Germain M, et al. Using urinary biomarkers to reduce acute kidney injury following cardiac surgery. J Thorac Cardiovasc Surg 2020:160:1235-1246.e2.
Fang L, Yu G, Huang J, Zhao W, Ye B. Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis. J Cardiothorac Surg 2020;15:148.
Graziani MP, Moser M, Bozzola CM, et al. Acute kidney injury in children after cardiac surgery: Risk factors and outcomes. A retrospective, cohort study. Arch Argent Pediatr 2019;117:e557-e567.
Hames DL, Ferguson MA, Kaza AK, et al. Renal replacement therapy in the pediatric cardiac intensive care unit. J Thorac Cardiovasc Surg 2019;158:1446-1455.
Hatton GE, Du RE, Wei S, et al. Positive fluid balance and association with post-traumatic acute kidney injury. J Am Coll Surg 2020;230:190-199.e1.
Ho J, Tangri N, Komenda P, et al. Urinary, plasma, and serum biomarkers’ utility for predicting acute kidney injury associated with cardiac surgery in adults: A meta-analysis. Am J Kidney Dis 2015;66:993-1005.
Howitt SH, Grant SW, Caiado C, et al. The KDIGO acute kidney injury guidelines for cardiac surgery patients in critical care: A validation study. BMC Nephrol 2018;19:149.
Husain-Syed F, Quattrone MG, Ferrari F, et al. Clinical and operative determinants of acute kidney injury after cardiac surgery. Cardiorenal Med 2020;10:340-352.
Jacob KA, Leaf DE. Prevention of cardiac surgery-associated acute kidney injury: A review of current strategies. Anesthesiol Clin 2019;37:729-749.
Joannidis M, Druml W, Forni LG, et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med 2017;43:730-749.
Kristovic D, Horvatic I, Husedzinovic I, et al. Cardiac surgery-associated acute kidney injury: Risk factors analysis and comparison of prediction models. Interact Cardiovasc Thorac Surg 2015;21:366-373.
Leballo G, Chakane PM. Cardiac surgery-associated acute kidney injury: Pathophysiology and diagnostic modalities and management. Cardiovasc J Afr 2020;31:205-212.
Meersch M, Schmidt C, Hoffmeier A, et al. Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med 2017;43:1551-1561.
Murashima M, Nishimoto M, Kokubu M, et al. Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery. Sci Rep 2019;9:20260.
Nishimoto M, Murashima M, Kokubu M, et al. Positive association between intra-operative fluid balance and post-operative acute kidney injury in non-cardiac surgery: The NARA-AKI cohort study. J Nephrol 2020;33:561-568.
O’Neal JB, Shaw AD, Billings FT 4th. Acute kidney injury following cardiac surgery: Current understanding and future directions. Crit Care 2016;20:187.
Padmanabhan H, Siau K, Curtis J, et al. Preoperative anemia and outcomes in cardiovascular surgery: Systematic review and meta-analysis. Ann Thorac Surg 2019;108:1840-1848.
Park SK, Hur M, Kim E, et al. Risk factors of acute kidney injury after congenital cardiac surgery in infants and children: A retrospective observational study. PLoS One 2016;11:e0166328.
Ramos KA, Dias CB. Acute kidney injury after cardiac surgery in patients without chronic kidney disease. Braz J Cardiovasc Surg 2018;33:454-461.
Rasmussen SR, Kandler K, Nielsen RV, et al. Duration of critically low oxygen delivery is associated with acute kidney injury after cardiac surgery. Acta Anaesthesiol Scand 2019;63:1290-1297.
Romagnoli S, Ricci Z, Ronco C. Perioperative acute kidney injury: Prevention, early recognition, and supportive measures. Nephron 2018;140:105-110.
Sanaiha Y, Kavianpour B, Dobaria V, et al. Acute kidney injury is independently associated with mortality and resource use after emergency general surgery operations. Surgery 2020;167:328-334.
Shen Z, Lin J, Teng J, et al. Association of urinary ionomic profiles and acute kidney injury and mortality in patients after cardiac surgery. J Thorac Cardiovasc Surg 2020;159:918-926.e5.
Sutherland L, Hittesdorf E, Yoh N, et al. Acute kidney injury after cardiac surgery: A comparison of different definitions. Nephrology (Carlton) 2020;25:212-218.
Thomas M, Kreibich M, Beyersdorf F, Benk C, Maier S, Trummer G. Standardized weaning from temporary extracorporeal life support in cardiovascular patients. Thorac Cardiovasc Surg 2020;68:425-432.
Tseng PY, Chen YT, Wang CH, et al. Prediction of the development of acute kidney injury following cardiac surgery by machine learning. Crit Care 2020;24:478.
Ueno K, Shiokawa N, Takahashi Y, et al. Kidney disease: Improving global outcomes in neonates with acute kidney injury after cardiac surgery. Clin Exp Nephrol 2020;24:167-173.
Vlasov H, Juvonen T, Hiippala S, et al. Effect and safety of 4% albumin in the treatment of cardiac surgery patients: study protocol for the randomized, double-blind, clinical ALBICS (ALBumin In Cardiac Surgery) trial. Trials 2020;21:235.
Wu B, Chen J, Yang Y. Biomarkers of acute kidney injury after cardiac surgery: A narrative review. Biomed Res Int 2019;2019:7298635.
Yuan SM. Acute kidney injury after cardiac surgery: Risk factors and novel biomarkers. Braz J Cardiovasc Surg 2019;34:352-360.
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