References of "Krzesinski, Jean-Marie"
     in
Bookmark and Share    
Full Text
Peer Reviewed
See detailMDRD VERSUS CKD-EPI EQUATIONS TO ESTIMATE GLOMERULAR FILTRATION RATE IN OBESE PATIENTS
BOUQUEGNEAU, Antoine ULg; CAVALIER, Etienne ULg; Krzesinski, Jean-Marie ULg et al

in Nephrology Dialysis Transplantation (2013, April 18), 28(supplément 1), 117-139

Introduction and Aims: Obesity is recognized as a risk factor both for the development and progression of chronic kidney disease (CKD). Estimating glomerular filtration rate (GFR) is thus especially ... [more ▼]

Introduction and Aims: Obesity is recognized as a risk factor both for the development and progression of chronic kidney disease (CKD). Estimating glomerular filtration rate (GFR) is thus especially important to follow these patients. We have tested the performances of two creatinine-based equations, namely the MDRD and CKD-EPI equations, in an obese population. Conclusions :Both in the global and subgroup analyses, the CKD-EPI equation did not outperform the MDRD study equation. The performances of both equations were worse in CKD patients. These two conclusions were still valid if indexed GFR was considered. [less ▲]

Detailed reference viewed: 21 (1 ULg)
Full Text
See detailKDIGO – prise en charge de l’hypertension artérielle en dialyse
Krzesinski, Jean-Marie ULg

Conference (2013, March 28)

1. A lower target may be chosen in CKD patients with proteinuria but after individualized risk-benefit assessment. The price to pay is a need for a higher number of antiHTA drugs and a risk of more ... [more ▼]

1. A lower target may be chosen in CKD patients with proteinuria but after individualized risk-benefit assessment. The price to pay is a need for a higher number of antiHTA drugs and a risk of more frequent side-effects. 2. Confirmation of a high BP level is necessary through out-of-the clinic BP measurement In CKD, ABPM offers night-time BP information useful for CV and renal risk evaluation. BP variability is a new point to be considered in the future. Proteinuria but also other specific risk factors (Phosphate, anemia, inflammation,..) should be integrated in the management of hypertension in CKD [less ▲]

Detailed reference viewed: 28 (2 ULg)
Full Text
See detailIntérêts et limites de la dialyse nocturne
Krzesinski, Jean-Marie ULg

Conference (2013, March 14)

Detailed reference viewed: 14 (1 ULg)
Full Text
Peer Reviewed
See detailCreatinine - or cystatin C - based equations to estimate glomerular filtration in the general population: impact on the epidemiology of chronic kidney disease
DELANAYE, Pierre ULg; CAVALIER, Etienne ULg; Moranne, Olivier et al

in BMC Nephrology (2013), 14

Chronic kidney disease (CKD) is a major issue in public health. Its prevalence has been calculated using estimation of glomerular filtration rate (GFR) by the creatinine-based equations developed in the ... [more ▼]

Chronic kidney disease (CKD) is a major issue in public health. Its prevalence has been calculated using estimation of glomerular filtration rate (GFR) by the creatinine-based equations developed in the Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study. Recently, new equations based either on cystatin C (CKD-EPI Cys) or both cystatin and creatinine (CKD-EPI mix) have been proposed by the CKD-EPI consortium. The aim of this study was to measure the difference in the prevalence of stage 3 CKD, defined as an estimated GFR less than 60 mL/min/1.73 m2, in a population using these four equations. METHODS: CKD screening was performed in the Province of Liege, Belgium. On a voluntary basis, people aged over 50 years have been screened. GFR was estimated by the four equations. Stage 3 CKD was defined as a GFR less than 60 mL/min/1.73 m2. RESULTS: The population screened consisted of 4189 people (47% were men, mean age 63 +/- 7y). Their mean serum creatinine and plasma cystatin C levels were 0.88 +/- 0.21 mg/dL and 0.85 +/- 0.17 mg/L, respectively. The prevalence of CKD in this population using the MDRD, the CKD-EPI, the CKD-EPI Cys and the CKD-EPI mix equations was 13%, 9.8%, 4.7% and 5%, respectively. The prevalence of CKD was significantly higher with the creatinine-based (MDRD and the CKD-EPI) equations compared to the new cystatin C-based equations. CONCLUSIONS: Prevalence of CKD varies strongly depending on the method used to estimate GFR. Such discrepancies are of importance and must be confirmed and explained by additional studies, notably by studies using GFR measured with a reference method [less ▲]

Detailed reference viewed: 50 (19 ULg)
Full Text
See detailStratification du risque cardiovasculaire selon la fonction
Krzesinski, Jean-Marie ULg

Conference (2013, March 09)

Detailed reference viewed: 17 (2 ULg)
Full Text
See detailHypertension artérielle résistante : place actuelle de la dénervation rénale dans sa prise en charge
Krzesinski, Jean-Marie ULg

Conference (2013, March 05)

HTA résistante touche 8% de la population hypertendue Nécessité d’une approche méthodique pour débusquer l’erreur dans la prise en charge Importance des médicaments interférant, du gain de poids et de ... [more ▼]

HTA résistante touche 8% de la population hypertendue Nécessité d’une approche méthodique pour débusquer l’erreur dans la prise en charge Importance des médicaments interférant, du gain de poids et de l’alimentation trop salée. Recherche d’un SAHOS Haute dose de diurétique et souvent association avec la spironolactone. Et si cela résiste? …dDénervation rénale? 1% des hypertendus traités! [less ▲]

Detailed reference viewed: 19 (0 ULg)
Full Text
Peer Reviewed
See detailParathormone and bone-specific alkaline phosphatase for the follow-up of bone turnover in hemodialysis patients : Is it so simple?
DELANAYE, Pierre ULg; DUBOIS, Bernard ULg; JOURET, François ULg et al

in Clinica Chimica Acta (2013), 417

Background: Chronic Kidney Disease (CKD) is associated with mineral and bone disorders (MBD). International guidelines suggest that levels of serum parathormone (PTH) or bone-specific alkaline phosphatase ... [more ▼]

Background: Chronic Kidney Disease (CKD) is associated with mineral and bone disorders (MBD). International guidelines suggest that levels of serum parathormone (PTH) or bone-specific alkaline phosphatase (b-ALP) can be used to evaluate MBD in dialysis patients. The evidence remains moderate and based on transversal studies. <br />Methods: We retrospectively investigated the variations of PTH (ΔPTH) and b-ALP (Δb-ALP) serum concentrations over a short (6-weeks) and a long (one-year) period in a monocentric hemodialysis population. The proportion of patients reaching the critical difference (CD) (50% for PTH and 25% for b-ALP) was calculated. <br />Results: Seventy-seven patientswere included. A significant correlation between PTHand b-ALP levelswas found at baseline (r=0.51). By contrast, no correlation was observed between ΔPTH and Δb-ALP over a 6-week interval (r=0.07). The CD for PTH and b-ALP was reached by 19 and 11 patients, respectively, with 2 patients showing consistent variations of both biomarkers. One year later, measurements were repeated in 48 survivors. <br />No correlation was found between ΔPTH and Δb-ALP (r=0.27). The CD for PTH or b-ALP was reached by 24 patients and 28 patients, respectively, with 6 patients (12.5%) showing opposite results for both biomarkers. <br />Conclusion: This study shows the lack of correlation between ΔPTH and Δb-ALP over time in patients under chronic hemodialysis. [less ▲]

Detailed reference viewed: 44 (17 ULg)
Full Text
Peer Reviewed
See detailPeritoneal equilibration test with conventional ‘low pH/high glucose degradation product’ or with biocompatible ‘normal pH/low glucose degradation product’ dialysates: does it matter?
VAN OVERMEIRE, Lionel ULg; Goffin, Eric; Krzesinski, Jean-Marie ULg et al

in Nephrology Dialysis Transplantation (2013)

Abstract Background. The evaluation of the peritoneal transport characteristics is mandatory in peritoneal dialysis (PD) patients. This is usually performed in routine clinical practice with a peritoneal ... [more ▼]

Abstract Background. The evaluation of the peritoneal transport characteristics is mandatory in peritoneal dialysis (PD) patients. This is usually performed in routine clinical practice with a peritoneal equilibration test (PET) using conventional dialysates, with low pH and high glucose degradation product (GDP) concentrations. An increasing proportion of patients are now treated with biocompatible dialysates, i.e. with physiological pH and lower GDP concentrations. This questions the appropriateness to perform a PET with conventional solutions in those patients. The aim of our study is to compare the results of the PET using biocompatible and conventional dialysates, respectively. Methods. Nineteen stable PD patients (13 males, 6 females; mean age: 67.95 ± 2.36 years, mean body surface area: 1.83 ± 0.04 m2, dialysis vintage: 2.95 ± 0.19 years) were included, among which 10 were usually treated with biocompatible and 9 with conventional solutions. Two PETs were performed, within a 2-week interval, in each patient. PET sequence (conventional solution first or biocompatible solution first) was randomized in order to avoid ‘time bias’. Small (urea, creatinine and glucose), middle (beta-2-microglobulin) and large molecules’ (albumin and alpha-2-macroglobulin) dialysate/plasma (D/P) concentration ratios and clearances were measured during each PET. Ultrafiltration (UF) and sodium filtration were also recorded. Results of both tests were compared by the Wilcoxon paired test. Results. No statistical difference was found between both dialysates for small molecule transport rates or for sodium filtration and UF. However, a few patients were not similarly classified for small-solute transport characteristics within the PET categories. Beta-2-microglobulin and albumin D/P ratios at different time points of the PET were significantly higher with the biocompatible, when compared with the conventional, solutions: 0.10 ± 0.03 versus 0.08 ± 0.02 (P < 0.01) and 0.008 ± 0.003 versus 0.007 ± 0.003 (P = 0.01), respectively. A similar difference was also observed for beta-2-microglobulin that was higher with biocompatible dialysates (1.04 ± 0.32 versus 0.93 ± 0.32 mL/min, respectively). Conclusion. Peritoneal transport of water and small solutes is independent of the type of dialysate which is used. This is not the case for the transport of beta-2-microglobulin and albumin that is higher under biocompatible dialysates. Vascular tonus modification could potentially explain such differences. The PET should therefore always be carried out with the same dialysate to make longitudinal comparisons possible. [less ▲]

Detailed reference viewed: 35 (5 ULg)
Full Text
Peer Reviewed
See detailPlace de l'AMP-activated protein kinase dans le preconditionnement ischemique renal.
Erpicum, Pauline; Krzesinski, Jean-Marie ULg; Jouret, François ULg

in Nephrologie & therapeutique (2013)

Kidney transplantation represents the best treatment of end-stage renal disease. In addition to the degree of human leukocyte antigen matching, long-term graft survival is influenced by the quality of the ... [more ▼]

Kidney transplantation represents the best treatment of end-stage renal disease. In addition to the degree of human leukocyte antigen matching, long-term graft survival is influenced by the quality of the graft before its transplantation. Quality criteria include the level of ischemic damage caused by the transplantation per se. Renal ischemic preconditioning (IP) consists of different approaches to prevent ischemia/reperfusion (I/R) damage induced by the interruption and recovery of renal circulation, as observed during transplantation. Distinct animal models show promising results regarding the efficiency of PCI to preserve kidney structure and function in I/R conditions. Characterizing the cellular cascades involved in I/R led to the identification of putative targets of renal IP, including the adenosine monophosphate-activated protein kinase (AMPK). AMPK is a ubiquitous energy sensor, which has been implicated in the maintenance of epithelial cell polarization under energy deprivation. Among others, the anti-diabetic drug, metformin, is a potent activator of AMPK. Here, we summarize the in vitro and in vivo data about the role of AMPK in renal IP. Defining the pharmacological conditions of IP would help to improve the quality of the renal graft before its transplantation, thereby increasing its long-term survival. [less ▲]

Detailed reference viewed: 35 (12 ULg)
Full Text
Peer Reviewed
See detailL'hypotension orthostatique: 2eme partie. Epidemiologie, complications et traitements.
Tyberghein, M.; Philips, J.-C.; Krzesinski, Jean-Marie ULg et al

in Revue Médicale de Liège (2013), 68(4), 163-70

Orthostatic hypotension (OH) is a rather common phenomenon in clinical practice. It may occur in 5-10 % of normal individuals, but its prevalence increases with age and various pathologies, so that it may ... [more ▼]

Orthostatic hypotension (OH) is a rather common phenomenon in clinical practice. It may occur in 5-10 % of normal individuals, but its prevalence increases with age and various pathologies, so that it may rise above 35 % in certain subgroups of patients. OH is associated with various comorbidities, in particular cardio-cerebro-vascular accidents and falls (especially in the elderly), and may even increase mortality. It is, however, difficult to determine whether OH is simply a marker of frailty or whether it is really a risk factor. OH treatment involves physical manoeuvres or medications, which aim at inducing a peripheral vasoconstriction (midodrine, etilefrine) or an increase of circulating blood volume (9-alpha-fluohydrocortisone). However, their use should be cautious, because of a risk of arterial hypertension in supine position. [less ▲]

Detailed reference viewed: 47 (1 ULg)
Full Text
Peer Reviewed
See detailL'Hypotension orthostatique: 1ere partie: definition, symptomatologie, evaluation et physiopathologie.
Tyberghein, Maelle; PHILIPS, Jean-Christophe ULg; Krzesinski, Jean-Marie ULg et al

in Revue Médicale de Liège (2013), 68(2), 65-73

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but ... [more ▼]

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but may also be rather vague. Diagnosis may be easily made by the physician in his/ her office, and confirmed, if necessary, by more sophisticated measurements. Pathophysiology is generally rather complex, but mostly involves a defect in the autonomic nervous system, in its sympathetic component. Failure of peripheral vasoconstriction seems to play a more important role than the defect in reflex tachycardia. Causes of OH are multiples. OH may occur in healthy subjects, when exposed to exceptional circumstances, but is more generally associated with various diseases, either neurological disorders or pathologies characterized by hypovolemia. Medications can also aggravate the risk of OH, among which some antihypertensive or psychotropic agents. Elderly people, especially frailty subjects, are exposed to a high risk of OH, whose origin is often multifactorial, and this complication may have serious medical consequences. [less ▲]

Detailed reference viewed: 61 (8 ULg)
Full Text
Peer Reviewed
See detailTolvaptan in autosomal dominant polycystic kidney disease.
JOURET, François ULg; Krzesinski, Jean-Marie ULg

in New England Journal of Medicine [=NEJM] (2013), 368(13), 1258-9

Detailed reference viewed: 43 (6 ULg)
Full Text
See detailLes syndromes cardio-rénaux
Krzesinski, Jean-Marie ULg

Learning material (2013)

Detailed reference viewed: 23 (4 ULg)
Full Text
See detailHyperuricémie et risque cardiovasculaire dans la maladie rénale chronique
Krzesinski, Jean-Marie ULg

Scientific conference (2012, December 20)

Plusieurs études de populations ont noté qu’une hyperuricémie peut favoriser l’apparition d’une insuffisance rénale. Par ce biais, l’hyperuricémie participerait au risque CV de l’IRC! Acide urique accru ... [more ▼]

Plusieurs études de populations ont noté qu’une hyperuricémie peut favoriser l’apparition d’une insuffisance rénale. Par ce biais, l’hyperuricémie participerait au risque CV de l’IRC! Acide urique accru: bon, mauvais ou indifférent? Rôle antioxydant à concentration normale A concentration élevée, épidémiologie en faveur d’un rôle délétère sur le plan CV et rénal (marqueur ou acteur?). Participe à la dysfonction endothéliale, à la stimulation du SRA, au stress oxydant et à l’inflammation, tous facteurs de risque CV. Rôle dans l’initiation et la progression de l’IRénale Cependant, EBM non prouvé de l’intérêt du traitement IXO Manque cruel d’études multicentriques, randomisées, contrôlées sur l’intérêt d’une baisse de l’acide urique par un IXO pour la protection CV et rénale ! [less ▲]

Detailed reference viewed: 48 (4 ULg)
Full Text
See detailCoronary heart disease: the MONICA-BELLUX Register
JeanJean, Michel; Krzesinski, Jean-Marie ULg; Wunsch, Guillaume

Conference (2012, December 05)

Background : Cardiovascular diseases contribute to 42% of overall mortality in the European Union. Over a third of deaths from CVD are from coronary heart disease and just over a quarter are from ... [more ▼]

Background : Cardiovascular diseases contribute to 42% of overall mortality in the European Union. Over a third of deaths from CVD are from coronary heart disease and just over a quarter are from cerebrovascular disease (stroke). Standardized death rates for heart disease have fallen dramatically in the last 25 years in Western Europe, both for men and for women. Multinational MONItoring of trends and determinants in CArdiovascular disease The MONICA Project : A major source of information on cardiovascular diseases established in the early 1980s under the auspices of WHO, to monitor trends in cardiovascular diseases and to relate these to risk factor changes over a ten year period. There were a total of 37 MONICA Collaborating Centres in 21 countries (including 29 populations in 16 European countries). The ten year data collection was completed in the late 1990s, though several Centres are still active today. Conclusions : CVD registers remain nevertheless an invaluable source for monitoring levels and trends in incidence and case fatality. Trends in incidence rates and in case fatality rates can significantly differ from one another. This situation requires better detection of individuals at risk. The intervention component of the BELLUX register is well-suited for this task. [less ▲]

Detailed reference viewed: 38 (1 ULg)
Full Text
See detailL'insuffisance rénale aiguë dans le décours d'une chirurgie cardiaque adulte: incidence au Centre Hospitalier Universitaire de Liège
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Scientific conference (2012, November 20)

Cadre théorique En chirurgie cardiaque, l’insuffisance rénale aiguë (IRA) est une complication postopératoire sévère et est associée à une augmentation du taux de mortalité, de morbidité et des durées de ... [more ▼]

Cadre théorique En chirurgie cardiaque, l’insuffisance rénale aiguë (IRA) est une complication postopératoire sévère et est associée à une augmentation du taux de mortalité, de morbidité et des durées de séjour aux soins intensifs (SI). Elle survient dans 5 à 30 % des cas selon le type de définition utilisée (1,2). Objectifs L’objectif de cette étude est de présenter un état des lieux de l’IRA survenant dans le décours d’une chirurgie cardiaque, dans notre Centre. Matériel et Méthodes Cette étude rétrospective inclut des patients pris en charge pour une chirurgie cardiaque entre le 1er avril 2008 et le 31 mars 2009. Les patients sélectionnés sont des opérés de : pontages aorto-coronaires avec CEC (PAC CEC), pontages aorto-coronaires à cœur battant (PAC battant), remplacement valvulaire aortique (RVA), remplacement ou réparation valvulaire mitral (RVM), ou remplacement valvulaire aortique associé à des pontages aorto-coronaires (RVA+PAC). Les insuffisants rénaux chroniques dialysés, en période préopératoire, sont exclus. La classification RIFLE (Risk, Injury, Failure, Loss and End stage kidney disease) permet de stratifier les patients en trois grades de sévérité d’IRA. Cette stratification est basée sur l’élément le plus péjoratif observé durant les 7 premiers jours postopératoires : augmentation du niveau de créatinine sérique ou diminution de la diurèse, ou diminution de la filtration glomérulaire selon les critères définis par Bellomo (3). La fréquence d’IRA est étudiée par type de chirurgie ainsi que son impact sur les durées de séjour aux SI et hospitalier. Les proportions sont comparées par un test du Chi2 et les valeurs médianes par un test U de Mann Whitney. Les résultats sont considérés comme étant significatifs au niveau d’incertitude de 5% (p<0.05). Résultats Quatre cent trente-quatre patients sont inclus : âge médian (interquartiles) 69.0 (60.0-76.0) ans, 30.2% de femmes, 2.76 de cas urgents. Cinquante-huit patients (13.4%) sont opérés par la technique PAC battant, 182 (41.9%) PAC CEC, 104 (24.0%) RVA, 44 (10.1%) RVM et 46 (10.6%) RVA+PAC. Une IRA est diagnostiquée chez 213 (49.1%) patients : 79 (37.1%) « Risk », 108 (50.7%) « Injury » et 26 (12.2%) « Failure ». La distribution d’IRA par type de chirurgie est respectivement égale à 36.2% pour le groupe PAC battant, 44.0% PAC CEC, 49.0% RVA, 52.3 RVM et 82.6% RVA+PAC. La fréquence d’IRA diffère significativement selon le type d’intervention chirurgicale (p<0.0001). Les durées de séjour aux SI sont statistiquement plus longues (p<0.0001) pour le groupe de patients ayant développé une IRA, respectivement : 3(2-4) jours versus 2(2-3) jours. Cependant, il n’y a pas de différence (p=0.65) observée entre les deux groupes (IRA et non IRA) en termes de durées de séjour hospitalier : 13 (10-18) jours versus 12 (10-16) jours. Discussion L’incidence d’IRA est très élevée dans cette population de patients, comparée aux données disponibles dans la littérature. Cela est probablement dû au fait que les trois éléments de la classification RIFLE ont été utilisés sur toute la population de l’étude. Conclusions L’IRA après chirurgie cardiaque associée à la CEC devrait être étudiée, à l’avenir pour développer des mesures préventives pour réduire les IRA. [less ▲]

Detailed reference viewed: 49 (8 ULg)
Full Text
See detailCardiac surgery and acute kidney injury: retrospective study
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Conference (2012, October 27)

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units ... [more ▼]

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units (ICU). It occurs in 5% to 30% of patients depending on the definition used [1] [2] [3]. The aim of this study is to present an overview of AKI following cardiac surgery associated or not with cardiopulmonary bypass, in our center. Methods: This retrospective study includes patients treated by cardiac surgery from April 1st, 2008 to March 31th, 2009 in a single center. We selected patients who underwent on-pump coronary artery bypass surgery (CABG), off-pump CABG (OPCAB), aortic valve replacement, mitral valve repair or replacement and aortic valve replacement combined with CABG. Patients undergoing renal replacement therapy preoperatively were excluded. The RIFLE classification (Risk, Injury, Failure, Loss and End stage kidney disease) allowed stratifying the patients into the 3 grades of AKI severity. The stratification was based on the most pejorative element observed within 7 days after surgery: increased serum creatinine level or decreased urine output, or decreased glomerular filtration rate according to criteria of Bellomo [4]. Occurrence of AKI was studied by type of cardiac surgery as its impact on the length of stay in ICU and in the hospital. Proportions were compared by the Chi-square test and median values by the Mann-Whitney U test. Results were considered significant at p < 0.05. Results: Four hundred and thirty-four patients were included: median (IQR) age 69.0(60.0-76.0) year, 30.2% females, 2.76% urgent/emergent cases. Fifty-eight patients (13.4%) underwent OPCAB, 182(41.9%) on-pump CABG, 104(24.0%) aortic valve replacement, 44(10.1%) mitral valve repair or replacement and 46(10.6%) aortic valve replacement combined with CABG. AKI occurred in 213(49.1%) patients: 79(37.1%) “Risk”, 108(50.7%) “Injury” and 26(12,2%) “Failure”. Distribution of AKI by type of surgery was equal to 36.2% among OPCABG, 44.0% on-pump CABG, 49.0% aortic valve replacement, 52.3% mitral valve surgery and 82.6% aortic valve replacement combined with CABG, respectively. AKI occurrences differed significantly according to the type of surgery (p<0.0001). Lengths of stay in ICU were significantly longer (p<0.0001) in AKI group compared with non AKI group: 3(2-4) days versus 2(2-3) days. However, no difference (p = 0.65) was observed between the two (AKI and NON-AKI) groups in hospital length of stay: 13(10-18) days versus 12(10-16) days. Conclusions: The incidence of AKI is very high in this population as compared to the literature. This may be due to the fact that the three elements of the RIFLE classification for all the population studied have been used. This study emphasizes the need for clear definition of AKI in order to compare different studies adequately. AKI after cardiac surgery with cardiopulmonary bypass would be further studied in order to develop more appropriate preventive measures. [less ▲]

Detailed reference viewed: 37 (8 ULg)
Full Text
See detailCardiac surgery and acute kidney injury: retrospective study
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Conference (2012, September 29)

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units ... [more ▼]

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units (ICU). It occurs in 5% to 30% of patients depending on the definition used [1] [2] [3]. The aim of this study is to present an overview of AKI following cardiac surgery associated or not with cardiopulmonary bypass. Methods: This retrospective study includes patients treated by cardiac surgery from April 1st, 2008 to March 31th, 2009 in a single center. We selected patients who underwent on-pump coronary artery bypass surgery (CABG), off-pump CABG (OPCAB), aortic valve replacement, mitral valve repair or replacement and aortic valve replacement combined with CABG. Patients undergoing renal replacement therapy preoperatively were excluded. The RIFLE classification (Risk, Injury, Failure, Loss and End stage kidney disease) allowed to stratify the patients into the 3 grades of AKI severity. The stratification was based on the most pejorative element observed within 7 days after surgery: increased serum creatinine level or decreased urine output, or decreased glomerular filtration rate according to criteria of Bellomo [4]. Occurrence of AKI was studied by type of cardiac surgery as its impact on the length of stay in ICU and in the hospital. Proportions were compared by the Chi-square test and median values by the Kruskal-Wallis. Results were considered significant at p < 0.05. Results: Four hundred and thirty four patients were included: median (IQR) age 69.0(60.0-76.0) year, 30.2% females, 2.76% urgent/emergent cases. Fifty-eight patients (13.4%) underwent OPCAB, 182(41.9%) on-pump CABG, 104(24.0%) aortic valve replacement, 44(10.1%) mitral valve repair or replacement and 46(10.6%) aortic valve replacement combined with CABG. AKI occurred in 213(49.1%) patients: 79(37.1%) “Risk”, 108(50.7%) “Injury” and 26(12,2%) “Failure”. Occurrence of AKI after OPCAB was 21(9.86%), CABG 80(37.6%), aortic valve replacement 51(23.9%), mitral valve surgery 23(10.8%) and aortic valve replacement combined with CABG 38(17.8%). AKI occurrences differed significantly between the different groups of surgery (p<0.0001). Lengths of stay in ICU were significantly longer (p<0.0001) in AKI group compared with non AKI group: 3(2-4) days versus 2(2-3) days. No difference (p = 0.65) was observed between the two (AKI and NON-AKI) groups in hospital length of stay: 13(10-18) days versus 12(10-16) days. Conclusions: The incidence of AKI is very high in this population as compared to the literature. This may be due to the fact that the three elements of the RIFLE classification for all the population studied have been used: serum creatinine level, urine output and glomerular filtration rate. This study emphasizes the need for clear definition of AKI in order to compare adequately different studies. AKI after cardiac surgery with cardiopulmonary bypass would be further studied in order to develop more appropriate preventive measures. [less ▲]

Detailed reference viewed: 33 (3 ULg)