Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) in Adults and Pediatrics; Prevention is the Optimal Management

Authors

  • Abdulaziz A. Alghamdi, MBBS Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
  • Mohammed O. Aqeeli, MBBS Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
  • Fahad K. Alshammari, MBBS Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
  • Saud M. Altalhi, MBBS Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
  • Abdullah M. Bajebair, MBBS Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
  • Khalid E. Al-Ebrahim, FRCSC Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia

DOI:

https://doi.org/10.1532/hsf.4881

Keywords:

Acute Kidney Injury, Heart surgery, Cardiac Surgery-Associated Acute Kidney Injury, CSA-AKI

Abstract

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant and severe complication that affects morbidity and mortality. We studied both pediatric and adult patients using the Acute Kidney Injury Network (AKIN) definition.

Methods: This was an observational retrospective cohort study done at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, and approved by the ethical committee. The exclusion criteria were baseline serum creatinine (SCr) ≥ 4 mg/dL or preexisting renal failure requiring dialysis, reoperation, death within 24 hours postoperatively, and operative mortality or missing data. We included 941 patients in the analysis using statistical software SPSS, version 15.0.

Results: Of the total number of patients, 28.68% in the adult group and 20.07% in the pediatric group developed CSA-AKI. Adult risk factors included the age group 60-69 years, cardiopulmonary bypass (CPB), number of grafts, and hypertension. In the pediatric group, CPB, aortic cross-clamping (ACX), and the lower preoperative SCr were the main risk factors

Conclusion: Conventional conservative management and preoperative identification of predictor risk factors are essential for preventing CSA-AKI, constituting the primary strategy for optimal management.

References

Al-Ebrahim KE, Al-Ebrahim E. 2020. Prevention, Classification and Management Review of Deep Sternal Wound Infection. The Heart Surgery Forum. Sep 14 (Vol. 2020, p. 3153).

Bellomo R, Ronco C, Kellum JA, et al. 2004. Acute Renal Failure - Definition, Outcome Measures, Animal Models, Fluid Therapy and Information Technology Needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical Care, vol. 8, no. 4. 204. 10.1186/cc2872.

Cardoso B, Laranjo S, Gomes I, et al. 2016. Insuficiência renal aguda no contexto de cirurgia cardíaca pediátrica: fatores de risco e prognóstico. Proposta de um modelo preditivo [Acute kidney injury after pediatric cardiac surgery: risk factors and outcomes. Proposal for a predictive model]. Rev Port Cardiol. 35:99-104.

Elassal AA, Al-Ebrahim K, Debis RS, Ragab ES, Faden MS, Fatani MA, Allam AR, et al. 2021. "Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate." Journal of Cardiothoracic Surgery 16, no. 1 1-11.

Elassal AA, Al-Ebrahim K, Makhdoom AM, Fatani M, Ibrahim M. 2021. Hybrid Coronary Revascularization: Perspective Current State After 25 Years of Start. InThe Heart Surgery Forum. Apr 27 (Vol. 2021, p. 3693).

Gomez H, Ince C, De Backer D, Pickkers P, Payen D, Hotchkiss J, et al. 2014. A unified theory of sepsis-induced acute kidney injury: inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury. Shock. 41:3-11.

Guan C, Li C, Xu L, et al. 2019. Risk factors of cardiac surgery-associated acute kidney injury: development and validation of a perioperative predictive nomogram. J Nephrol. 32:937-945.

Haase M, Haase-Fielitz A, Bagshaw SM, Ronco C, Bellomo R. 2007. Cardiopulmonary bypass-associated acute kidney injury: a pigment nephropathy?. Contrib Nephrol. 156:340-53.

Harky A, Joshi M, Gupta S, Teoh WY, Gatta F, Snosi M. 2020. Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review. Braz J Cardiovasc Surg. 35:211-224.

Hoste EA, Cruz DN, Davenport A, et al. 2008. The epidemiology of cardiac surgery-associated acute kidney injury. Int J Artif Organs. 31:158-165.

Jiang W, Shen B, Wang Y, Xu J, Luo Z, Ding X, Teng J. 2019. Potentially Modifiable Predictors for Renal Replacement Therapy in Patients with Cardiac Surgery Associated-Acute Kidney Injury: a Propensity Score-Matched Case-Control Study. Braz J Cardiovasc Surg. 34:33-40.

Karim HM, Yunus M, Saikia MK, Kalita JP, Mandal M. 2017. Incidence and progression of cardiac surgery-associated acute kidney injury and its relationship with bypass and cross clamp time. Ann Card Anaesth. 20:22-27.

Karkouti K, Wijeysundera DN, Yau TM, et al. 2009. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 119:495-502.

Kim JH, Kim HJ, Kim JY, Ahn Hs, Ahn IM, Choe WJ, Lim CH. 2015. Meta-Analysis of Sodium Bicarbonate Therapy for Prevention of Cardiac Surgery-Associated Acute Kidney Injury. J Cardiothorac Vasc Anesth. 29:1248-56.

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.

Li S, Krawczeski CD, Zappitelli M, et al. 2011. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. 39:1493-9.

Lopez-Delgado JC EF, Torrado H, Rodríguez-Castro D, et al. 2013. Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification. Crit Care. 293-210.

Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A. 2017. 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. Epub. 43:1551-1561.

Mehta RH, Grab JD, O’Brien SM, et al. 2006. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation. 114:2208-16.

Moon H, Lee Y, Kim S, et al. 2018. Differential signature of obesity in the relationship with acute kidney injury and mortality after coronary artery bypass grafting. Journal of Korean medical science.

O'Neal JB, Shaw AD, Billings FT 4th. 2016. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 4:187.

Ronco C, Kellum JA, Bellomo R. 2008. Cardiac surgery-associated acute kidney injury. International Journal of Artificial Organs. 31:156-157.

Sandokji I, Greenberg JH. 2020. Novel biomarkers of acute kidney injury in children: an update on recent findings. Curr Opin Pediatr. 32:354-359.

Schetz M, Bove T, Morelli A, Mankad S, Ronco C, Kellum JA. 2008. Prevention of cardiac surgery-associated acute kidney injury. Int J Artif Organs. 31:179-89.

Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. 2005. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 16:162-168.

Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. 2005. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function. Kidney Int. 67:1112- 1119.

Uchino S, Kellum JA, Bellomo R, et al. 2005. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 294:813-818.

Vaschetto R, Groeneveld AB. 2007. An update on acute kidney injury after cardiac surgery. Acta Clinica Belgica. Supplementum. 380:384.

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

Wijeysundera DN, Karkouti K, Dupuis JY, et al. 2007. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA. 297:1801-1809.

Zangrillo A, Biondi-Zoccai GG, Frati E, et al. 2012. Fenoldopam and acute renal failure in cardiac surgery: a meta-analysis of randomized placebo-controlled trials. J Cardiothorac Vasc Anesth. 26:407-13.

Published

2022-07-12

How to Cite

Alghamdi, A. A., Aqeeli, M. O., Alshammari, F. K., Altalhi, S. M., Bajebair, A. M., & Al-Ebrahim, FRCSC, K. E. (2022). Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) in Adults and Pediatrics; Prevention is the Optimal Management. The Heart Surgery Forum, 25(4), E504-E509. https://doi.org/10.1532/hsf.4881

Issue

Section

Articles