Predictors of Early Deterioration of Renal Function in Patients Older Than 70 Years Undergoing Valvular Surgery

Authors

  • Ljiljana Ranković-Ničić, MD Clinic for Anesthesia and Intensive Care, Dedinje Cardiovascular Institute, Belgrade, Serbia
  • Dragana Unić-Stojanović, MD, PhD Clinic for Anesthesia and Intensive Care, Dedinje Cardiovascular Institute, Belgrade, Serbia
  • Maja Milošević, MD Cardiology Services, Dedinje Cardiovascular Institute, Belgrade, Serbia
  • Slobodan Mićović, MD, PhD Belgrade University School of Medicine, Belgrade, Serbia
  • Tjaša Ivošević, MD, PhD Belgrade University School of Medicine, Belgrade, Serbia
  • Milica Stojicic, MD Clinic for Anesthesia and Intensive Care, Dedinje Cardiovascular Institute, Belgrade, Serbia
  • Petar Otašević, MD, PhD Cardiology Services, Dedinje Cardiovascular Institute, Belgrade, Serbia

DOI:

https://doi.org/10.1532/hsf.4387

Keywords:

Acute kidney injury, cardiac surgery

Abstract

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open-heart surgery, with an incidence between 8.9% and 39%. Studies have shown that even a slight increase in serum creatinine levels after cardiac surgery significantly affects the mortality and morbidity of these patients.

Aim: This study sought to determine the predictors and incidence of acute kidney injury (AKI) in patients older than 70 years undergoing elective valvular surgery.

Methods: Prospective study included 156 patients scheduled for elective cardiac surgery requiring cardiopulmonary bypass (CPB) at Dedinje Cardiovascular Institute between January and September 2019. Isolated valvular surgery was performed in 87 patients, while the remaining 69 patients underwent combined coronary and valvular surgery. The development and stage of CSA-AKI were diagnosed, according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Predictors and incidence of CSA-AKI development were assessed using univariate binary logistic regression analysis.

Results: The incidence of CSA-AKI was 17.3%. CSA-AKI stage 1 was diagnosed in 25 patients  (16.02%). CSA-AKI stage 2 was noted in one patient (0.64%), as well as stage 3 (0.64%). In six patients (3.85%), renal replacement therapy (RRT) was required. Using univariate binary logistic analysis, the following parameters were identified as predictors for CSA-AKI development: duration of cardiopulmonary bypass (OR 1.01; CI 95% (1.01-1.02); P = .002), duration of aortic clamping (OR 1.02; CI 95% (1.01-1.03); P = .002), lactate levels during the intensive care unit (ICU) stay (OR 1.33; CI 95% (1.04-1.70); P = .026), duration of mechanical ventilation (MV) (OR 1.03; CI 95% (1.1-1.07); P = .014), the use of inotropic drugs (adrenaline, dobutamine) (OR 0.38: CI 95% (0.16-0.9); P = .026; and OR 0.23; CI 95% (0.1-0.56); P = .0019, respectively), and the use of diuretics (OR 0.24; CI95% (0.06-095); P = .041). Using Mann-Whitney U test for independent samples show that the group of patients who developed CSA-AKI had significantly longer duration of hospitalization (Z = -2.751); P = .006), prolonged ICU stay
(Z = -4.160; P < .001), and need for prolonged mechanical ventilation (Z = -4.411; P < .001).

Conclusion: Independent predictors for AKI development after valvular surgery in patients older than 70 years are prolonged mechanical ventilation and increased lactate values, while the use of diuretics after surgery reduces the incidence of AKI. Also, the development of CSA-AKI is associated with prolonged ICU stay and a longer duration of hospitalization.

References

Akker J, Egal M, Groeneveld J. 2013. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care 17:R98.

Bangash MN, Kong M, Pearse RM. 2012. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol. 165: 2015–2033.

Boldt J, Brenner T, Lehmann A, Suttner SW, Kumle B, Isgro F. 2003. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg. 75:906-12.

Brown JR, Kramer RS, Coca SG, Parikh CR. 2010. Duration of acute kidney injury impacts long-term survival after cardiac surgery. Ann Thorac Surg. 90:1142–1148.

Cartin-Ceba R, Kashiouris M, Plataki M, Kor DJ, Gajic O, Casey ET. 2012. Risk factors for development of acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Res Pract. 691013.

Chandiraseharan VK, Kalimuthu M, Prakash TV, et al. 2020. Acute kidney injury is an independent predictor of in-hospital mortality in a general medical ward: A retrospective study from a tertiary care centre in south India. Indian J Med Res. 152:386-392.

Coleman, MD, Shaefi S, Sladen RN. 2011. Preventing acute kidney injury aftercardiac surgery. Curr Opin Anaesthesiol. 24:70–76.

Fujii T, Kurata H, Takaoka M, et al. 2003. The role of renal sympathetic nervous system in the pathogenesis of ischemic acute renal failure. Eur J Pharmacol. 481:241–248.

Grams ME, Estrella MM, Coresh J, Brower RG, Liu KD. 2011. Fluid balance, diuretic use, and mortality in acute kidney injury. Clin J Am Soc Nephrol. 6:966-973.

Habib RH, Zacharias A, Schwann TA, et al. 2005. Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit Care Med. 33:1749-56.

Hajjar LA, Almeida JP, Fukushima JT, et al. 2013. High lactate levels are predictors of major complications after cardiac surgery. J Thorac Cardiovasc Surg. 146:455–460.

Hu J, Chen R, Liu S, Yu X, Zou J, Ding X. 2016. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 30:82-89.

Jarnberg PO. 2004. Renal protection strategies in the perioperative period. Best Pract Res Clin Anaesthesiol. 18:645-60.

Jason B, O’Neal, Andrew D, Shaw, Billings TF. 2016. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 20:187.

Khwaja A. 2012. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clinical practice. 120:179-184.

Kolli H, Rajagopalam S, Patel N, et al. 2010. Mild acute kidney injury is associated with increased mortality after cardiac surgery in patients with EGFR <60 ml/min/1.73 m2. Ren Fail. 32:1066–1072.

Lassnigg A, Donner E, Grubhofer G, Presetrl 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.

Mao H, Katz N, Ariyanon W, et al. 2013. Cardiac surgery-associated acute kidney injury. Cardiorenal Med. 3:178-199.

Moss E, Lamarche Y. 2012. Acute Kidney Injury Following Cardiac Surgery: Prevention, Diagnosis, and Management, Renal Failure - The Facts, Dr. Momir Polenakovic (Ed.), ISBN: 978-953-51-0630-2, InTech.

Rosner MH, Portilla D, Okusa MD. 2008. Cardiac surgery as a cause of acute kidney injury: pathogenesis and potential therapies. J Intensive Care Med. 23:3–18.

Tuttle KR, Worrall NK, Dahlstrom LR, Nandagopal R, Kausz AT, Davis CL. 2003. Predictors of ARF after cardiac surgical procedures. Am J Kidney Dis. 41:76-83.

Vandenberghe W, Gevaert S, Kellum JA, et al. 2016. Acute kidney injury in cardiorenalsyndrome type 1 patients: a systematic review and meta-analysis. Cardiorenal Med. 6:116-128.

Wang Y, Bellomo R. 2017. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol. 13:697-711.

Zhongheng Z, Hongying N. 2015. Normalized Lactate Load Is Associated with Development of Acute Kidney Injury in Patients Who Underwent Cardiopulmonary Bypass Surgery. Cardiopulmonary Bypass Surgery. PLoS One. 10:e0120466.

Published

2022-03-17

How to Cite

Ranković-Ničić, L., Unić-Stojanović, D., Milošević, M., Mićović, S., Ivošević, T., Stojicic, M., & Otašević, P. (2022). Predictors of Early Deterioration of Renal Function in Patients Older Than 70 Years Undergoing Valvular Surgery. The Heart Surgery Forum, 25(2), E196-E203. https://doi.org/10.1532/hsf.4387

Issue

Section

Articles