Risk Factors and Outcomes of Acute Kidney Injury after Type A Aortic Dissection Surgery at A Tertiary Care Hospital
DOI:
https://doi.org/10.31584/jhsmr.2021846Keywords:
acute kidney injury, aortic dissection surgery, risk factorAbstract
Objective: This study aimed to determine the risk factors predisposing to postoperative acute kidney injury (AKI) after type A aortic dissection repair; regarding patient-related, surgery-related and anesthesia-related factors.
Material and Methods: A retrospective cohort study was conducted in patients who underwent type A aortic dissection repair under cardiopulmonary bypass (CPB), during the periods from January 2008 and December 2019. Patient-related, surgery-related and anesthesia-related factors were evaluated for association with AKI. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. The outcomes and mortality of AKI were also investigated.
Results: Included were 95 patients, and the incidence of AKI was 65.3%. The 30-day mortality resulted only in the AKI group (14.9%). From multivariate logistic regression analysis, receiving intraoperative cryoprecipitate (odd ratio; OR 14.18; 95% confidence interval (CI), 3.27-61.5) and PRC transfusion (OR 1.001; 95% CI, 1.0005-1.002) in ICU were the risk factors for AKI. The protective factors were: higher preoperative serum bicarbonate levels (OR 0.83; 95% CI, 0.70- 0.99), higher volume of urine output during CPB (OR 0.71; 95% CI, 0.55-0.91) and higher immediate postoperative mean arterial pressure (OR 0.95; 95% CI, 0.92-0.98). Thirty-day mortality was significantly higher in the AKI group (14.5% vs 0%; p-value=0.025), and 15.0% of patients required renal replacement therapy.
Conclusion: The higher level of three factors including preoperative serum bicarbonate levels (>23 mmol/l), volume of urine output during CPB and immediate postoperative mean arterial pressure (>81 mmHg) are likely to be the protective factors of AKI.
References
Sasabuchi Y, Kimura N, Shiotsuka J, Komuro T, Mouri H, Ohnuma T, et al. Long-term survival in patients with acute kidney injury after acute type A aortic dissection repair. Ann Thorac Surg 2016;102:2003–9.
Ko T, Higashitani M, Sato A, Uemura Y, Norimatsu T, Mahara K, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol 2015;116:463–8.
Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology 2011;114:964–70.
O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care 2016;20:187.
Vives M, Hernandez A, Parramon F, Estanyol N, Pardina B, Mu oz A, et al. Acute kidney injury after cardiac surgery: prevalence, impact and management challenges. Int J Nephrol Renovasc Dis 2019;12:153–66.
Wang X, Ren HM, Hu CY, Que B, Ai H, Wang CM, et al. Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection. J Geriatr Cardiol 2016;13:679–84.
Kim WH, Park MH, Kim HJ, Lim HY, Shim HS, Sohn JT, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta. Medicine (Baltimore) 2015;94:e273.
Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009;119:495– 502.
Goren O, Matot I. Perioperative acute kidney injury. Br J Anaesth 2015;115(Suppl 2):ii3-14.
Borthwick E, Ferguson A. Perioperative acute kidney injury: risk factors, recognition, management, and outcomes. BMJ 2010;341:c3365.
Motayagheni N, Phan S, Eshraghi C, Nozari A, Atala A. A review of anesthetic effects on renal function: potential organ protection. Am J Nephrol 2017;46:380–9.
Howitt SH, Grant SW, Caiado C, Carlson E, Kwon D, Dimarakis I, et al. The KDIGO acute kidney injury guidelines for cardiac surgery patients in critical care: a validation study. BMC Nephrol 2018;19:149.
Roh GU, Lee JW, Nam SB, Lee J, Choi J, Shim YH. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg 2012;94: 766–71.
Tsai HS, Tsai FC, Chen YC, Wu LS, Chen SW, Chu JJ, et al. Impact of acute kidney injury on one-year survival after surgery for aortic dissection. Ann Thorac Surg 2012;94: 1407–12.
Arnaoutakis GJ, Bihorac A, Martin TD, Hess PJ, Klodell CT, Ejaz AA, et al. RIFLE criteria for acute kidney injury in aortic arch surgery. J Thorac Cardiovasc Surg 2007;134:1554–61.
D’Onofrio A, Cruz D, Bolgan I, Auriemma S, Cresce GD, Fabbri A, et al. RIFLE criteria for cardiac surgery-associated acute kidney injury: risk factors and outcomes. Congest Heart Fail 2010;16(Suppl 1):S32-6.
Bove T, Calabr MG, Landoni G, Aletti G, Marino G, Crescenzi G, et al. The incidence and risk of acute renal failure after cardiac surgery. J Cardiothorac Vasc Anesth 2004;18:442–5.
Liu Y, Han L, Li J, Gong M, Zhang H, Guan X. Consumption coagulopathy in acute aortic dissection: principles of management. J Cardiothorac Surg 2017;12:50.
Li CN, Ge YP, Liu H, Zhang CH, Zhong YL, Chen SW, et al. Blood transfusion and acute kidney injury after total aortic arch replacement for acute Stanford type A aortic dissection. Heart Lung Circ 2021;S1443-9506(21)00549-7.
Lee SH, Lee SM, Kim CS, Cho HS, Lee JH, Lee CH, et al. Fibrinogen recovery and changes in fibrin-based clot firmness after cryoprecipitate administration in patients undergoing aortic surgery involving deep hypothermic circulatory arrest. Transfusion 2014;54:1379–87.
Tomita Y, Shimode N, Ide T, Ueki R, Tatara T, Tashiro C. Efficacy of cryoprecipitate transfusion for coagulopathy after cardiopulmonary bypass in thoracic aortic surgery. Masui 2011;60: 830–4.
Callum JL, Karkouti K, Lin Y. Cryoprecipitate: the current state of knowledge. Transfus Med Rev 2009;23:177–88.
Gameiro J, Lopes JA. Complete blood count in acute kidney injury prediction: a narrative review. Ann Intensive Care 2019;9:87.
Radi ZA. Immunopathogenesis of acute kidney injury. Toxicol Pathol 2018;46:930–43.
Sinauridze EI, Kireev DA, Popenko NY, Pichugin AV, Panteleev MA, Krymskaya OV, et al. Platelet microparticle membranes have 50- to 100-fold higher specific procoagulant activity than activated platelets. Thromb Haemost 2007;97: 425–34.
Liu S, Wang X, Lu Y, Li T, Gong Z, Sheng T, et al. The effects of intraoperative cryoprecipitate transfusion on acute renal failure following orthotropic liver transplantation. Hepatol Int 2013;7:901–9.
Kindzelski BA, Corcoran P, Siegenthaler MP, Horvath KA. Postoperative acute kidney injury following intraoperative blood product transfusions during cardiac surgery. Perfusion 2018;33:62–70.
Jung SY, Park JT, Kwon YE, Kim HW, Ryu GW, Lee SA, et al. Preoperative low serum bicarbonate levels predict acute kidney injury after cardiac surgery. Medicine (Baltimore) 2016;95:e3216.
Shah SN, Abramowitz M, Hostetter TH, Melamed ML. Serum bicarbonate levels and the progression of kidney disease: a cohort study. Am J Kidney Dis 2009;54:270–7.
Haase M, Haase-Fielitz A, Plass M, Kuppe H, Hetzer R, Hannon C, et al. Prophylactic perioperative sodium bicarbonate to prevent acute kidney injury following open heart surgery: a multicenter double-blinded randomized controlled trial. PLoS Med 2013;10:e1001426.
Palomba H, de Castro I, Neto ALC, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney Int 2007;72:624–31.
Hori D, Katz NM, Fine DM, Ono M, Barodka VM, Lester LC, et al. Defining oliguria during cardiopulmonary bypass and its relationship with cardiac surgery-associated acute kidney injury. Br J Anaesth 2016;117:733–40.
Song Y, Kim DW, Kwak YL, Kim BS, Joo HM, Ju JW, et al. Urine output during cardiopulmonary bypass predicts acute kidney injury after cardiac surgery: a single-center retrospective analysis. Medicine (Baltimore) 2016;95:e3757.
Meng L, Yu W, Wang T, Zhang L, Heerdt PM, Gelb AW. Blood pressure targets in perioperative care. Hypertension 2018;72: 806–17.
Gold JP, Charlson ME, Williams-Russo P, Szatrowski TP, Peterson JC, Pirraglia PA, et al. Improvement of outcomes after coronary artery bypass. A randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg 1995;110:1302–14.
Charlson ME, Peterson JC, Krieger KH, Hartman GS, Hollenberg JP, Briggs WM, et al. Improvement of outcomes after coronary artery bypass II: a randomized trial comparing intraoperative high versus customized mean arterial pressure. J Card Surg 2007;22:465–72.
Vedel AG, Holmgaard F, Rasmussen LS, Langkilde A, Paulson OB, Lange T, et al. High-target versus low-target blood pressure management during cardiopulmonary bypass to prevent cerebral injury in cardiac surgery patients: a randomized controlled trial. Circulation 2018;137:1770–80.
Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 2002;21:232–44.
Laffey JG, Boylan JF, Cheng DCH. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 2002;97:215–52.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
