|Reference : Cardiac surgery and acute kidney injury: retrospective study|
|Scientific congresses and symposiums : Unpublished conference/Abstract|
|Human health sciences : Surgery|
|Cardiac surgery and acute kidney injury: retrospective study|
|LAGNY, Marc-Gilbert [Centre Hospitalier Universitaire de Liège - CHU > > Bloc opératoire chirurgie cardio-vasculaire >]|
|BLAFFART, Francine [Centre Hospitalier Universitaire de Liège - CHU > > Bloc opératoire chirurgie cardio-vasculaire >]|
|Defraigne, Jean-Olivier [Université de Liège - ULg > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique >]|
|Donneau, Anne-Françoise [Université de Liège - ULg > Département des sciences de la santé publique > Département des sciences de la santé publique >]|
|ROEDIGER, Laurence [Centre Hospitalier Universitaire de Liège - CHU > > Anesthésie et réanimation >]|
|Krzesinski, Jean-Marie [Université de Liège - ULg > Département des sciences cliniques > Néphrologie >]|
|13 th Symposium on perfusion "Questioning the obvious in CPB practice"|
|29 septembre 2012|
|The Belgian Society of Extracorporeal Technology (BelSECT)|
|[en] cardiac surgery ; cardiopulmonary bypass ; acute kidney injury|
|[en] 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   . 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 . 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.
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.
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