Impact of Intraoperative Ultrafiltration on the Development of Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Cardiac Surgery

Kanjana Thana; Thitipong Tepsuwan; Umpaipan Thana

Authors

Kanjana Thana Department of Fundamental Nursing, Faculty of Nursing, Chiang Mai University, Thailand https://orcid.org/0000-0002-5356-1958
Thitipong Tepsuwan Department of Surgery,Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand
Umpaipan Thana Department of Surgery, Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0002-8259-7204

Keywords:

ultrafiltration, chronic kidney disease, acute kidney injury, cardiac surgery

Abstract

OBJECTIVE To evaluate the incidence and effectiveness of using ultrafiltration in chronic kidney disease (CKD) patients during cardiac surgery.

METHODS A retrospective record review of all chronic kidney disease patients who underwent cardiac surgery at a university hospital medical center in Thailand from January 2013 to December 2018.

RESULTS Data from 306 eligible CKD patients were analyzed. The average age of patients was 63.89 ± 10.05 years. Two-hundred and twenty-two patients were male (72.2%). More than half of the patients (162/306 or 52.9%) underwent ultrafiltration (UF) during cardiopulmonary bypass (CPB). During the postoperative period, CKD patients who had received the UF were more likelyto have higher postoperative serum creatinine after surgery and on post-operation day 1 (p < 0.01). However, there was no statistically significant difference in the occurrence of acute kidney injury (AKI) among CKD patients who received ultrafiltration and those who did not.

CONCLUSIONS In this study, the ultrafiltration intervention did not reduce the incidence of AKI among patients with CKD who underwent cardiac surgery during CPB. However, further prospective investigation is needed to fully evaluate the contribution of ultrafiltration in reducing the risk of developing postoperative AKI among patients with preexisting renal failure.

References

1. Vellinga S, Verbrugghe W, De Paep R, Verpooten GA, Janssen van Doorn K. Identification of modifiable risk factors for acute kidney injury after cardiac sugery. Neth J Med 2012 Dec;70(10):450-4.

2 . Skarupskienė l, Adukauskienė D, Kuzminskienė J, Rimkutė L, Balčiuvienė V, Žiginskienė E, et al. Mortality prediction in patients with acute kidney injury requiring renal replacement therapy after cardiac surgery. Medicina 2017;53(4):217-223.

3. O’Neal, J.B., Shaw, A.D. & Billings, F.T. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care 20, 187 (2016). https://doi.org/10.1186/s13054-016-1352-z

4. Huen SC, Parikh CR. Predicting acute kidney injury after cardiac surgery: a systematic review. Ann Thorac Surg. 2012;93(1):337–47.

5. Durmaz, I et al. Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure. The Journal of thoracic and cardiovascular surgery vol. 118,2 (1999): 306-15. doi:10.1016/S0022-5223(99)70221-7

6. Kumar A, Suneja M, Riou B. Cardiopulmonary Bypass–associated Acute Kidney Injury. Anesthesiology 2011; 114:964–970 doi: https://doi.org/10.1097/ALN.0b013e318210f86a

7. Lannemyr L, Bragadottir G, Krumbholz V, et al. Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery. Anesthesiology 2017; 126:205–213 doi: https://doi.org/10.1097/ALN.0000000000001461

8. Ortega-Loubon C, Fernández-Molina M, Carrascal-Hinojal Y, Fulquet-Carreras E. Cardiac surgery-associated acute kidney injury. Ann Card Anaesth 2016 Oct-Dec;19(4):687-698.

9. Grünenfelder J, Zünd G, Schoeberlein A, et al. Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults. Eur J Cardiothorac Surg. 2000;17(1):77-83. doi:10.1016/s1010-7940(99)00355-3

10. Kiziltepe U, Uysalel A, Corapcioglu T, Dalva K, Akan H, Akalin H. Effects of combined conventional and modified ultrafiltration in adult patients. Ann Thorac Surg. 2001 Feb;71(2):684-93.

11. Kuntz, RA, Holt, DW, Turner S, Stichka L, Thacker B. Effects of conventional ultrafiltration on renal performance during adult cardiopulmonary bypass procedures. J Extra Corpor Technol.2006 Jun:38(2):144-153.

12. Luciani GB, Menon T, Vecchi B, Auriemma S, Mazzucco A. Modified ultrafiltration reduces morbidity after adult cardiac operations: a prospective, randomized clinical trial. Circilation. 2001 Sep 18;104(12 Suppl 1):I253-9.

13. Long DM, Jenkins E, Griffith K. Perfusionist techniques of reducing acute kidney injury following cardiopulmonary bypass: an evidence-based review. Perfusion. 2015;30(1):25-32. doi:10.1177/0267659114544395

14. Lopes JA, Jorge S. The RIFLE and AKIN classification for acute kidney injury: a critical and comprehensive review. Clin Kidney J. 2013 Feb;6(1):8-14.

15. Paugh, Theron A et al. Impact of Ultrafiltration on Kidney Injury After Cardiac Surgery: The Michigan Experience. The Annals of thoracic surgery vol. 100,5 (2015): 1683-8. doi:10.1016/j.athoracsur.2015.04.120

16. Dehne, Marius G et al. Renal effects of cardiopulmonary bypass in the elderly. Perfusion vol. 17,3 (2002): 205-9. doi:10.1191/0267659102pf571oa

17. Bent, P et al. Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. The Annals of thoracic surgery vol. 71,3 (2001): 832-7. doi:10.1016/s0003-4975(00)02177-9

18. Yi, Qian et al. Risk Factors for Acute Kidney Injury after Cardiovascular Surgery: Evidence from 2,157 Cases and 49,777 Controls - A Meta-Analysis. Cardiorenal medicine vol. 6,3 (2016): 237-50. doi:10.1159/000444094