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Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, Susantitaphong P, Rocco M, Vanholder R, Sever MS, Cruz D, Jaber B, Lameire NH, Lombardi R, Lewington A, Feehally J, Finkelstein F, Levin N, Pannu N, Thomas B, Aronoff-Spencer E, Remuzzi G. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 2015; 385:2616-43. [PMID: 25777661 DOI: 10.1016/s0140-6736(15)60126-x] [Citation(s) in RCA: 677] [Impact Index Per Article: 75.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ravindra L Mehta
- Department of Medicine, University of California San Diego, San Diego, CA, USA.
| | - Jorge Cerdá
- Division of Nephrology, Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Emmanuel A Burdmann
- LIM 12, Division of Nephrology, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Guillermo García-García
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Vivekanand Jha
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Tufts University School of Medicine, Boston, MA, USA
| | - Michael Rocco
- Department of Internal Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium
| | - Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Mehmet, Turkey
| | - Dinna Cruz
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Bertrand Jaber
- Tufts University School of Medicine, Boston, MA, USA; St Elizabeth's Medical Center, Boston, MA, USA
| | - Norbert H Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium
| | - Raúl Lombardi
- Department of Critical Care Medicine, SMI, Montevideo, Uruguay
| | | | | | | | | | | | - Bernadette Thomas
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Department of Medicine, Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
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Chew STH, Ng RRG, Liu W, Goh SG, Caleb MG, Ti LK. Miniaturized versus conventional cardiopulmonary bypass and acute kidney injury after cardiac surgery. Perfusion 2015; 31:60-7. [DOI: 10.1177/0267659115584418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Acute kidney injury (AKI) is a serious complication after coronary artery bypass grafting (CABG). There are conflicting reports whether a miniaturized cardiopulmonary bypass (MCPB) system is associated with a lower AKI incidence compared with conventional cardiopulmonary bypass (CCPB). It is unknown if AKI risk factors differ between the two groups. We assessed if MCPB decreases AKI after CABG and compared the risk factors between both groups. Methods: Sixty-eight Asian patients presenting for elective CABG at a tertiary heart centre were enrolled. They were randomly assigned to MCPB (n=34) or CCPB group (n=34) and followed up in a single-blinded, prospective, randomized, controlled trial. The primary outcome was Acute Kidney Injury Network stage 1 AKI. Results: The AKI incidence was 21.5% and was not significantly different between patients undergoing MCPB versus CCPB (21.9% versus 21.2%, p=0.948). The first CPB haematocrit was independently associated with AKI in the MCPB group (Relative Risk [RR]=0.484, 95% Confidence Interval [CI]=0.268-0.876, p=0.016); post-operative blood loss and inflammation were independently associated with AKI in the CCPB group (RR=1.005, 95%CI=1.003-1.007, p<0.001; RR=1.018, 95%CI=1.010-1.028, p<0.001). Conclusion: The MCPB system is not associated with a lower incidence of AKI in Asian patients undergoing CABG. Risk factors for AKI differed between patients using the MCPB and CCPB systems.
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Affiliation(s)
- STH Chew
- Department of Anaesthesiology, Singapore General Hospital, Singapore
- Department of Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - RRG Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - W Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - SG Goh
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - MG Caleb
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - LK Ti
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Anaesthesia, National University Health System, Singapore
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Ng RRG, Myat Oo A, Liu W, Tan TE, Ti LK, Chew STH. Changing glucose control target and risk of surgical site infection in a Southeast Asian population. J Thorac Cardiovasc Surg 2015; 149:323-8. [DOI: 10.1016/j.jtcvs.2014.08.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/02/2014] [Accepted: 08/20/2014] [Indexed: 12/18/2022]
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Ng RRG, Chew STH, Liu W, Ong P, Caleb MG, Ti LK. The inflammatory response between miniaturised and conventional cardiopulmonary bypass after cardiac surgery in an Asian population. Perfusion 2014; 30:487-94. [PMID: 25501623 DOI: 10.1177/0267659114563779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We compared the systemic inflammatory response of the MCPB system to the CCPB system with cell salvage and phosphorylcholine-coated tubing amongst Asian patients undergoing coronary artery bypass grafting. METHODS Seventy-eight patients were randomly assigned to the MCPB or the CCPB groups equally and followed up in a prospective, single-blinded, randomised, controlled trial. Levels of TNF-α, IL-6, CRP and LDH were measured peri-operatively. RESULTS The systemic inflammatory response was similar in both groups (TNF-α: p=0.222; IL-6: p=0.991; CRP: p=0.258). Only haemolysis was significantly higher in the CCPB group (LDH: p=0.011). The MCPB system was twice more expensive, but had a near 4-fold cost saving in tranfusions. Overall, the MCPB system cost 20% more than the modified CCPB system. CONCLUSION These results corroborate with studies that demonstrated the avoidance of cardiotomy suction rather than the MCPB system, itself, leads to an attenuated inflammatory response. The absence of obvious clinical benefit and the higher costs involved with the MCPB system would preclude its routine use.
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Affiliation(s)
- R R G Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S T H Chew
- Department of Anaesthesiology, Singapore General Hospital, Singapore Department of Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - W Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P Ong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - M G Caleb
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - L K Ti
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore Department of Anaesthesia, National University Health System, Singapore
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Ge Ng RR, Huey Chew ST, Liu W, Kah Ti L. Persistent kidney injury at hospital discharge after cardiac surgery with cardiopulmonary bypass in patients with normal preoperative serum creatinine and normal estimated glomerular filtration rate. J Cardiothorac Vasc Anesth 2014; 28:1453-8. [PMID: 25263770 DOI: 10.1053/j.jvca.2014.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Acute kidney injury is a serious complication after cardiac surgery. Although it resolves in most cases, a significant portion of patients persistently have raised creatinine values at hospital discharge. These patients are at greater risk for developing chronic kidney disease and mortality. Therefore, the present study aimed to ascertain risk factors of persistent acute kidney injury after cardiac surgery in patients with normal preoperative renal function. DESIGN Prospective cohort study. SETTING Tertiary heart centers. PARTICIPANTS 2,181 adult cardiac surgical patients, predominantly Asian. INTERVENTIONS Cardiac surgery between August 2008 and July 2012. MEASUREMENTS AND MAIN RESULTS The incidence of acute kidney injury, as defined by the Acute Kidney Injury Network stage 1 criteria, was 21.7%. At discharge, 10.5% of these patients had persistent kidney injury, which was defined as a ≥ 26.4 μmol/L (≥ 0.3 mg/dL) difference between preoperative and discharge creatinine levels and/or a 50% rise in serum creatinine. These patients were more likely to be aged ≥ 70 years (relative risk = 2.232, 95% confidence interval = 1.326-3.757, p = 0.003), have a higher peak postoperative creatinine value within 48 hours (relative risk = 1.007, 95% confidence interval = 1.004-1.010, p<0.001), and have lower hemoglobin on intensive care unit arrival (relative risk = 0.759, 95% confidence interval = 0.577-0.998, p = 0.048). CONCLUSIONS Age ≥ 70 years, higher peak postoperative creatinine within 48 hours, and lower hemoglobin on intensive care unit arrival are associated with persistent acute kidney injury. Strategies to improve hemoglobin on intensive care unit arrival potentially can reduce persistent acute kidney injury. The authors recommend that patients aged ≥ 70 years undergo further renal evaluation for better risk stratification.
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Affiliation(s)
- Roderica Rui Ge Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sophia Tsong Huey Chew
- Department of Anesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore; Cardiovascular and Metabolic Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Weiling Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lian Kah Ti
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Anesthesia, National University Health System, Singapore, Singapore.
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Kim KI, Lee WY, Ko HH, Kim HS, Jeong JH. Hemoglobin Level to Facilitate Off-Pump Coronary Artery Bypass without Transfusion. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:350-7. [PMID: 25207243 PMCID: PMC4157497 DOI: 10.5090/kjtcs.2014.47.4.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 11/28/2013] [Accepted: 11/30/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conservation of blood during cardiac surgery is important because of the shortage of donor blood, risks associated with transfusion, and the costs of allogeneic blood products. This retrospective study explored the feasibility of off-pump coronary artery bypass (OPCAB) without transfusion. METHODS One hundred and two consecutive patients underwent OPCAB from January 2007 to June 2012 at Hallym University Sacred Heart Hospital. Excluding 10 chronic renal failures patients, 102 patients were enrolled. Their characteristics, clinical data, and laboratory data were analyzed. We investigated the success rate of OPCAB without transfusion according to pre-operative hemoglobin (Hb), and the cutoff point of the Hb level and the risk factors for transfusion. We implemented multidisciplinary blood-saving protocols. RESULTS The overall operative mortality and the success rate of OPCAB without transfusion were 2.9% (3/102) and 73.5% (75/102). The success rates in patients with Hb<11, 11 <Hb<14, and 14<Hb were 35.0%, 79.2%, and 89.7% (p=0.01), respectively. The risk factors for transfusion are age>70 years, diagnosis of acute myocardial infarction, preoperative Hb and creatinine levels, and operation time. The events precipitating the need for transfusion were low Hb level in 9 patients and hypotension or excessive bleeding in 18 patients. CONCLUSION The preoperative Hb level of >11 facilitates OPCAB without transfusion. These results suggest that transfusion-free OPCAB can be performed by modifying the risk factors and correctable causes of transfusion and improving various blood salvage methods.
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Affiliation(s)
- Kun Il Kim
- Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine
| | - Won Yong Lee
- Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine
| | - Ho Hyun Ko
- Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine
| | - Hyoung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine
| | - Jae Han Jeong
- Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine
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Xue FS, Li RP, Liu GP. Modifiable risk factors for acute kidney injury after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2014; 148:366-7. [DOI: 10.1016/j.jtcvs.2014.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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Ng RRG, Chew STH, Liu W, Shen L, Ti LK. Reply to the editor. J Thorac Cardiovasc Surg 2014; 148:367-8. [PMID: 24939028 DOI: 10.1016/j.jtcvs.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Roderica Rui Ge Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Sophia Tsong Huey Chew
- Department of Anesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore, Republic of Singapore; Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore, Republic of Singapore
| | - Weiling Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Liang Shen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Lian Kah Ti
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of Anesthesia, National University Health System, Singapore, Republic of Singapore
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