Cardiac surgery and acute kidney injury: retrospective study
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1 Cardiac surgery and acute kidney injury: retrospective study Department of Cardiovascular and Thoracic Surgery University of Liege Hospital (ULg CHU), Belgium MG LAGNY 1, F BLAFFART 1, JO DEFRAIGNE 2, AF DONNEAU 3, L ROEDIGER 4, JM KRZESINSKI 5 1. ECCP, Department of Cardiovascular and Thoracic Surgery, ULg CHU. 2. MD, PhD, Chief Department of Cardiovascular and Thoracic Surgery, ULg CHU. 3. Medical Informatics and Biostatistics, Public Health, University of Liege. 4. MD, PhD, Department of Anesthesiology, ULg CHU. 5. MD, PhD, Chief Department of Nephrology-Dialysis, ULg CHU.
2 Acute Kidney Injury (AKI) in the setting of cardiac surgery INTRODUCTION: ü Severe postoperative complication ü Increase rate of mortality, morbidity and length of stay in intensive care unit (ICU) ü Occurrence: 5% to 42 % Rosner M, et al. Cardiac surgery as a cause of acute kidney injury: Pathogenesis and potential therapies. J Intensive Care Med 2008;23:3-18. Hobson CE, et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation 2009;119: Arora P, et al. Preventable Risk Factors for Acute Kidney Injury in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth Aug;26(4):
3 AIM OF THE STUDY: Occurrence by type of cardiac surgery? Length of stay in ICU and in Hospital? Mortality?
4 MATERIAL AND METHODS: Retrospective study: 1 year adult surgery Inclusion criteria Ø Off-pump coronary artery bypass surgery (Off-PUMP CABG) Ø On-pump coronary artery bypass surgery (On-PUMP CABG) Ø Aortic valve replacement (AVR) Ø Aortic valve replacement combined with CABG (AVR+CABG) Ø Mitral valve repair or replacement (MVR)
5 MATERIAL AND METHODS: Retrospective study: 1 year adult surgery Exclusion criteria Ø Mitral valve + CABG Ø Aorta surgery Ø Redo procedure Ø Other combined surgery (eg: + TEA carotid) Ø Double valve surgery Ø Heart transplant Ø Preoperative renal replacement therapy (RRT)
6 RIFLE classification Bellomo R, et al. Acute renal failure. Critical Care 2004, 8:R204-R212.
7 RESULTS : N= 598 cases (100.0%) Excluded cases n= 164 (27.4%) Included cases n= 434 (72.6%)
8 Type of surgery n= 434 (100%) MVR Off-PUMP CABG AVR+CABG n=44 10% n=58 13% n=46 11% AVR n=104 24% n=182 42% On-PUMP CABG
9 Postoperative renal status n= 434 (100%) NO AKI n=221 51% AKI n=213 49%
10 Postoperative renal status n=213 (100%) Failure AKI n=26 12% % Injury n=108 51% n=79 37% Risk
11 Postoperative renal status n=213 (100%) AKI Failure n=26 12% RRT = 8 (4%) % Injury n=108 51% n=79 37% Risk
12 Postoperative AKI: Failure MVR Off-PUMP CABG 100% 80% 60% 40% 20% 0% On-PUMP CABG AVR+CABG AVR AKI Failure RRT p<0.0001
13 Risk of AKI Off-PUMP CABG vs On-PUMP CABG Off-PUMP CABG n=58 On-PUMP CABG n=182 p value AKI, n (%) 21 (36.0) 80 (44.0) 0.29 Failure, n (%) 2 (3.00) 10 (5.00) 0.70 EuroSCORE 1 Log 2.72 ( ) 3.05 ( ) MI preop (<3 months), n (%) 4 (6.90) 39 (21.4) CABG (>2 vs 2), n (%) 21 (36.2) 134 (73.6) < ICU stay (days) 2.0 (2-3) 2.0 (2 4) Hospital stay (days) 11.5 (10 15) 12.0 (10 18) 0.14 Hospital mortality, n (%) 0 (0.00) 4 (2.20) 0.25 Data are expressed as M (IQR)
14 Risk of AKI CPB procedures Preoperative data Non AKI n=184 AKI n=192 p value Age (years) 66.0 (59-74) 72.0 (63-77) <0.001 BMI (UI) 25.7 (23-28) 26.9 (24-30) <0.001 GFR (ml/min) 82.0 (72-96) 70.5 (55-88) <0.001 Parsonnet Log 5.76 (3-12) 8.41 (4-17) <0.001 EuroSCORE I Log 3.60 (2-6) 4.98 (2-9) CIN score 4.27 (2-8) 6.44 (4-9) ARF score 1.00 (0-2) 2.00 (1-3) <0.001 Data are expressed as M (IQR) CIN score: Contrast Induced Nephropathy (Mehran and all, JACC Vol.44 No.7, 2004 October 6,2004:1393-9) ARF score: Acute Renal Failure Score (Charuhas and all, J Am Soc Nephrol 16: ,2005)
15 Risk of AKI CPB procedures Peroperative data Non AKI n=184 AKI n=192 p value CPB time (min) 85.0 (70-100) 89.0 (75-106) Clamping time (min) 52.0 (39-64) 58.0 (43-74) Nadir Hct 21%, n (%) 102 (55.4) 127 (66.5) RBC transfusion, n (%) 30 (16.3) 50 (26.5) UF, n (%) 21 (20.6) 11 (13.8) 0.22 UF, ml 1000 ( ) 1300 ( ) Data are expressed as M (IQR)
16 POSTOPERATIVE DATA CPB procedures Non AKI n=184 AKI n=192 p value ICU stay (days) 2.0 (2-3) 3.0 (2-4) Hospital stay (days) 12.0 (10-16) 13.0 (10-19) 0.49 Hospital mortality, n (%) 5 (2.72) 8 (4.17) 0.44 Data are expressed as M (IQR)
17 Probability of length of stay in ICU 1,0 Probability of length of stay (Klaplan-Meier) in intensive care unit by grade of gravity AKI. 0,9 0,8 Probability of length of stay. 0,7 0,6 0,5 0,4 0,3 0,2 p < ,1 0, Days RISK INJURY FAILURE
18 CONCLUSIONS Ø Limits Ø RIFLE classification Ø Large proportion of AKI Ø Length of stay Ø Great mortality with AKI FAILURE (RRT) Ø High risk patients Ø Prospective study
19 ACKNOWLEDGEMENT F BLAFFART D HELLA MP FISSETTE T AMAND M ERPICUM JN KOCH D BERTRAND THANK YOU Prof. JO DEFRAIGNE Prof. JM KRZESINSKI Dr L ROEDIGER AF DONNEAU
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