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Alam A, Jamil AK, Van Zyl JS, Medel-Martinez H, Bottiglieri T, Wasek B, Felius J, Lima B, Hall SA, Joseph SM. Urinary Cell-Cycle Arrest Biomarkers as Early Predictors of Acute Kidney Injury After Ventricular Assist Device Implantation or Cardiac Transplantation. J Cardiothorac Vasc Anesth 2021; 36:2303-2312. [PMID: 34774406 DOI: 10.1053/j.jvca.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Acute kidney injury (AKI) remains a leading source of morbidity and mortality after cardiothoracic surgery. Insulin-like growth factor-binding protein 7 (IGFBP7), and tissue inhibitor of metalloproteinases-2 (TIMP-2), are novel early-phase renal biomarkers that have been validated as sensitive predictors of AKI. Here the authors studied the efficacy of these biomarkers for predicting AKI after left ventricular assist device (LVAD) implantation and cardiac transplantation. DESIGN/SETTING/PARTICIPANTS/INTERVENTIONS This was a prospective study of 73 patients undergoing LVAD implantation (n = 37) or heart transplant (n = 36) from 2016 to 2017 at the authors' center. TIMP-2 and IGFBP7 were measured with the NephroCheck Test on urine samples before surgery and one-to-six hours after surgery. NephroCheck scores were assessed as predictors of moderate/severe AKI (Kidney Disease International Global Outcomes 2/3 creatinine criteria) within 48 hours of surgery, and the association with survival to one year was investigated. MEASUREMENTS AND MAIN RESULTS The LVAD and transplant cohorts overall were similar in demographics and baseline creatinine (p > 0.05), with the exception of having more African-American patients in the LVAD arm (p = 0.003). Eleven (30%) LVAD and 16 (44%) transplant patients developed moderate/severe AKI. Overall, AKI was associated with postsurgery NephroCheck (odds ratio [95% confidence interval] for 0.1 mg/dL increase: 1.36 [1.04-1.79]; p = 0.03), but not with baseline NephroCheck (p = 0.92). When analyzed by cohort, this effect remained for LVAD (1.68 [1.05-2.71]; p = 0.03) but not for transplant (p = 0.15). Receiver operating characteristic analysis showed postoperative NephroCheck to be superior to baseline creatinine in LVAD (p = 0.046). Furthermore, an increase of 0.1 mg/dL in postoperative NephroCheck was associated with a 10% increase in the risk of mortality (adjusted hazard ratio: 1.11 [1.01-1.21]; p = 0.04) independent of age and body mass index. CONCLUSION Assessment of TIMP-2 and IGFBP7 within six hours after surgery appeared effective at predicting AKI in patients with LVADs. Larger studies are warranted to validate these findings.
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Affiliation(s)
- Amit Alam
- Baylor University Medical Center, Dallas, TX; Baylor Scott & White Research Institute, Dallas, TX; Texas A&M Medical College, College Station, TX.
| | | | | | | | - Teodoro Bottiglieri
- Baylor University Medical Center, Dallas, TX; Baylor Scott & White Research Institute, Dallas, TX
| | | | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, TX
| | | | - Shelley A Hall
- Baylor University Medical Center, Dallas, TX; Baylor Scott & White Research Institute, Dallas, TX; Texas A&M Medical College, College Station, TX
| | - Susan M Joseph
- Medical City Heart Hospital, Dallas, TX; University of Maryland Medical Center, Baltimore, Maryland
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Candela-Toha Á, Pardo MC, Pérez T, Muriel A, Zamora J. Estimated glomerular filtration rate is an early biomarker of cardiac surgery-associated acute kidney injury. Nefrologia 2018; 38:596-605. [PMID: 29685332 DOI: 10.1016/j.nefro.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/14/2018] [Accepted: 01/22/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND and objective Acute kidney injury (AKI) diagnosis is still based on serum creatinine and diuresis. However, increases in creatinine are typically delayed 48h or longer after injury. Our aim was to determine the utility of routine postoperative renal function blood tests, to predict AKI one or 2days in advance in a cohort of cardiac surgery patients. PATIENTS AND METHODS Using a prospective database, we selected a sample of patients who had undergone major cardiac surgery between January 2002 and December 2013. The ability of the parameters to predict AKI was based on Acute Kidney Injury Network serum creatinine criteria. A cohort of 3,962 cases was divided into 2groups of similar size, one being exploratory and the other a validation sample. The exploratory group was used to show primary objectives and the validation group to confirm results. The ability to predict AKI of several kidney function parameters measured in routine postoperative blood tests, was measured with time-dependent ROC curves. The primary endpoint was time from measurement to AKI diagnosis. RESULTS AKI developed in 610 (30.8%) and 623 (31.4%) patients in the exploratory and validation samples, respectively. Estimated glomerular filtration rate using the MDRD-4 equation showed the best AKI prediction capacity, with values for the AUC ROC curves between 0.700 and 0.946. We obtained different cut-off values for estimated glomerular filtration rate depending on the degree of AKI severity and on the time elapsed between surgery and parameter measurement. Results were confirmed in the validation sample. CONCLUSIONS Postoperative estimated glomerular filtration rate using the MDRD-4 equation showed good ability to predict AKI following cardiac surgery one or 2days in advance.
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Affiliation(s)
- Ángel Candela-Toha
- Servicio de Anestesia y Reanimación, Hospital Universitario Ramón y Cajal (IRYCIS) Consorcio FRA (CIFRA) , Madrid, España.
| | - María Carmen Pardo
- Departamento de Estadística e Investigación Operativa, Facultad de Matemáticas, Universidad Complutense de Madrid , Madrid, España
| | - Teresa Pérez
- Departamento de Estadística e Investigación Operativa III, Facultad de Estudios Estadísticos, Universidad Complutense de Madrid , Madrid, España
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Javier Zamora
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España; Barts and The London School of Medicine and Dentistry, Queen Mary University, Londres, Reino Unido
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Guerci P, Claudot JL, Novy E, Settembre N, Lalot JM, Losser MR. Immediate postoperative plasma neutrophil gelatinase-associated lipocalin to predict acute kidney injury after major open abdominal aortic surgery: A prospective observational study. Anaesth Crit Care Pain Med 2017; 37:327-334. [PMID: 29033359 DOI: 10.1016/j.accpm.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Plasma neutrophil gelatinase-associated lipocalin (pNGAL) has been used as a biomarker in acute kidney injury (AKI). AKI is a common postoperative complication of aortic surgery. We sought to evaluate the performance of the immediately postoperative pNGAL level in comparison with the serum creatinine (SCr) level in predicting AKI and the need for renal replacement therapy (RRT). PATIENTS AND METHODS Prospective non-interventional study in a university hospital. Fifty patients undergoing elective or emergent major intra-abdominal aortic surgery were included. Comparisons between groups of patients with or without postoperative AKI, according to KDIGO staging, were made. Performance of NGAL was determined by examining the area under receiver operating characteristic (AUROC) curve. RESULTS The incidence of AKI was 36%. At H+2, pNGAL values in AKI and non-AKI patients, respectively, were 221 [133-278] versus 50 [50-90] ng/mL (P<0.0001), and SCr values were 115 [96-178] versus 90 [72-99] μmol/L (P<0.0008). The AUROC of pNGAL for prediction of AKI was 0.90 (95% CI: 0.81-0.98) with an optimal cutoff of 112ng/mL, a sensitivity of 83%, specificity of 84%, and positive and negative predictive values of 75% and 90%, respectively. SCr produced an AUROC curve of 0.79 (0.65-0.92) at a cutoff of 110μmol/L. The diagnostic performance of pNGAL was significantly better than that of SCr (P=0.039). PNGAL at H+2 better predicted the RRT requirement [0.96 (0.90-1.0)] compared to SCr [0.86 (0.73-0.98)], but this difference was not statistically significant. CONCLUSIONS A 2-hour postoperative determination of pNGAL outperformed SCr level in predicting postoperative AKI after major aortic surgery.
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Affiliation(s)
- Philippe Guerci
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Jean-Louis Claudot
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Emmanuel Novy
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Nicla Settembre
- Department of Vascular Surgery, University Hospital of Nancy - Brabois, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Jean-Marc Lalot
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Marie-Reine Losser
- Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
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Karim HMR, Yunus M, Saikia MK, Kalita JP, Mandal M. Incidence and progression of cardiac surgery-associated acute kidney injury and its relationship with bypass and cross clamp time. Ann Card Anaesth 2017; 20:22-27. [PMID: 28074790 PMCID: PMC5290689 DOI: 10.4103/0971-9784.197823] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Cardiac surgery-associated kidney injury (CSA-AKI) is common but relatively less is known about its progression. The present study is aimed at evaluating the incidence and course of CSA-AKI and its relationship with the different durations of cardiopulmonary bypass (CPB) and cross clamp times. MATERIALS AND METHODS Occurrences of CSA-AKI are evaluated as per the Akin Kidney Injury Network (AKIN) criteria over the course of 5 postoperative day (POD) in 100 patients. The relationship of different durations of CPB and aortic cross clamp time with CSA-AKI is analyzed by Chi-squared test for trend and other appropriate tests using INSTAT software. RESULTS One hundred (43 male, 57 female; mean age of 37.01 ± 12.28 years, and baseline mean serum creatinine 0.99 ± 0.20 mg %) patients undergone mostly valve replacement, and congenital heart disease correction was evaluated. Nearly 49% suffered CSA-AKI (81.63% AKIN Class I) with maximum numbers on 2 nd POD. Serum creatinine followed a falling trend 3 rd POD onward except in 8.16% cases of CSA-AKI. Oliguria was absent even in AKIN Class II. The CPB time >70 min and cross clamp time >60 min increase CSA-AKI risk by an OR of 4.76 and 2.84, respectively (P < 0.05). CONCLUSION CSA-AKI is very prevalent; mostly of AKIN Class I and increases with increasing CPB and cross clamp time. Urine output is not a reliable indicator of CSA-AKI. The AKIN Class II on the very 1 st POD or increasing trend of serum creatinine beyond 3 rd POD should alert for early intervention.
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Affiliation(s)
- Habib Md Reazaul Karim
- Department of Anaesthesiology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, India
| | - Mohd Yunus
- Department of Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India
| | - Manuj Kumar Saikia
- Department of Cardio Thoracic Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India
| | - Jyoti Prasad Kalita
- Department of Cardio Thoracic Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India
| | - Mrinal Mandal
- Perfusionist, Department of Cardio Thoracic Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India
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Ortega-Loubon C, Fernández-Molina M, Carrascal-Hinojal Y, Fulquet-Carreras E. Cardiac surgery-associated acute kidney injury. Ann Card Anaesth 2017; 19:687-698. [PMID: 27716701 PMCID: PMC5070330 DOI: 10.4103/0971-9784.191578] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-recognized complication resulting with the higher morbid-mortality after cardiac surgery. In its most severe form, it increases the odds ratio of operative mortality 3-8-fold, length of stay in the Intensive Care Unit and hospital, and costs of care. Early diagnosis is critical for an optimal treatment of this complication. Just as the identification and correction of preoperative risk factors, the use of prophylactic measures during and after surgery to optimize renal function is essential to improve postoperative morbidity and mortality of these patients. Cardiopulmonary bypass produces an increased in tubular damage markers. Their measurement may be the most sensitive means of early detection of AKI because serum creatinine changes occur 48 h to 7 days after the original insult. Tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 are most promising as an early diagnostic tool. However, the ideal noninvasive, specific, sensitive, reproducible biomarker for the detection of AKI within 24 h is still not found. This article provides a review of the different perspectives of the CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment. We searched the electronic databases, MEDLINE, PubMed, EMBASE using search terms relevant including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment, in order to provide an exhaustive review of the different perspectives of the CSA-AKI.
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Moriyama T, Hagihara S, Shiramomo T, Nagaoka M, Iwakawa S, Kanmura Y. Comparison of three early biomarkers for acute kidney injury after cardiac surgery under cardiopulmonary bypass. J Intensive Care 2016; 4:41. [PMID: 27330813 PMCID: PMC4915135 DOI: 10.1186/s40560-016-0164-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/15/2016] [Indexed: 12/15/2022] Open
Abstract
Background Acute kidney injury (AKI) is a serious complication after cardiac surgery, being associated with a high mortality. We assessed three urinary biomarkers, L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), and angiotensinogen, which are elevated through different mechanisms, and investigated which of these biomarkers was the earliest and most useful indicator of AKI after cardiac surgery. Methods This study was a prospective observational study conducted at a single-institution university hospital. All patients were adults aged under 80 years who underwent cardiac surgery with cardiopulmonary bypass between November 2013 and January 2015. Perioperatively, urine samples were obtained from all patients at five points. Based on AKI criteria, patients were divided into two groups: AKI group (n = 11) and non-AKI group (n = 39), according to postoperative serum creatinine (Cr) levels. Results Urinary L-FABP, NGAL, angiotensinogen, and Cr were measured perioperatively. L-FABP was significantly higher in the AKI group than in the non-AKI group at the end of surgery and 3 h after surgery. L-FABP levels were 601.5 ± 341.7 and 233.8 ± 127.2 μg/g Cr in the AKI and non-AKI groups, respectively. Three hours after surgery, NGAL levels were 950.5 ± 827.9 and 430.0 ± 250.6 μg/g Cr in the AKI and non-AKI groups, respectively, the level being significantly higher in the AKI group than in the non-AKI group. There were no significant differences in urinary angiotensinogen levels between the two groups at any time point. Conclusions We demonstrated the utility of L-FABP and NGAL, but not angiotensinogen in the early recognition of AKI. The problem of the different peak points among biomarkers needs to be resolved for discovery of a panel of biomarkers.
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Affiliation(s)
- Takahiro Moriyama
- Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201 Japan
| | - Shintaro Hagihara
- Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201 Japan
| | - Toko Shiramomo
- Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201 Japan
| | - Misaki Nagaoka
- Department of Anesthesiology and Critical Care Medicine, Kyusyu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 46201 Japan
| | - Shohei Iwakawa
- Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201 Japan
| | - Yuichi Kanmura
- Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201 Japan
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Baos S, Sheehan K, Culliford L, Pike K, Ellis L, Parry AJ, Stoica S, Ghorbel MT, Caputo M, Rogers CA. Normothermic versus hypothermic cardiopulmonary bypass in children undergoing open heart surgery (thermic-2): study protocol for a randomized controlled trial. JMIR Res Protoc 2015; 4:e59. [PMID: 26007621 PMCID: PMC4460263 DOI: 10.2196/resprot.4338] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/04/2015] [Indexed: 11/13/2022] Open
Abstract
Background During open heart surgery, patients are connected to a heart-lung bypass machine that pumps blood around the body (“perfusion”) while the heart is stopped. Typically the blood is cooled during this procedure (“hypothermia”) and warmed to normal body temperature once the operation has been completed. The main rationale for “whole body cooling” is to protect organs such as the brain, kidneys, lungs, and heart from injury during bypass by reducing the body’s metabolic rate and decreasing oxygen consumption. However, hypothermic perfusion also has disadvantages that can contribute toward an extended postoperative hospital stay. Research in adults and small randomized controlled trials in children suggest some benefits to keeping the blood at normal body temperature throughout surgery (“normothermia”). However, the two techniques have not been extensively compared in children. Objective The Thermic-2 study will test the hypothesis that the whole body inflammatory response to the nonphysiological bypass and its detrimental effects on different organ functions may be attenuated by maintaining the body at 35°C-37°C (normothermic) rather than 28°C (hypothermic) during pediatric complex open heart surgery. Methods This is a single-center, randomized controlled trial comparing the effectiveness and acceptability of normothermic versus hypothermic bypass in 141 children with congenital heart disease undergoing open heart surgery. Children having scheduled surgery to repair a heart defect not requiring deep hypothermic circulatory arrest represent the target study population. The co-primary clinical outcomes are duration of inotropic support, intubation time, and postoperative hospital stay. Secondary outcomes are in-hospital mortality and morbidity, blood loss and transfusion requirements, pre- and post-operative echocardiographic findings, routine blood gas and blood test results, renal function, cerebral function, regional oxygen saturation of blood in the cerebral cortex, assessment of genomic expression changes in cardiac tissue biopsies, and neuropsychological development. Results A total of 141 patients have been successfully randomized over 2 years and 10 months and are now being followed-up for 1 year. Results will be published in 2015. Conclusions We believe this to be the first large pragmatic study comparing clinical outcomes during normothermic versus hypothermic bypass in complex open heart surgery in children. It is expected that this work will provide important information to improve strategies of cardiopulmonary bypass perfusion and therefore decrease the inevitable organ damage that occurs during nonphysiological body perfusion. Trial Registration ISRCTN Registry: ISRCTN93129502, http://www.isrctn.com/ISRCTN93129502 (Archived by WebCitation at http://www.webcitation.org/6Yf5VSyyG).
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Affiliation(s)
- Sarah Baos
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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Najafi M. Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury. World J Cardiol 2014; 6:1006-1021. [PMID: 25276301 PMCID: PMC4176792 DOI: 10.4330/wjc.v6.i9.1006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 04/07/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
Serum creatinine is still the most important determinant in the assessment of perioperative renal function and in the prediction of adverse outcome in cardiac surgery. Many biomarkers have been studied to date; still, there is no surrogate for serum creatinine measurement in clinical practice because it is feasible and inexpensive. High levels of serum creatinine and its equivalents have been the most important preoperative risk factor for postoperative renal injury. Moreover, creatinine is the mainstay in predicting risk models and risk factor reduction has enhanced its importance in outcome prediction. The future perspective is the development of new definitions and novel tools for the early diagnosis of acute kidney injury largely based on serum creatinine and a panel of novel biomarkers.
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Bennett MJ, Weatherall M, Webb G, Dudnikov SF, Lloyd CT. The impact of haemodilution and bypass pump flow on cerebral oxygen desaturation during cardiopulmonary bypass--A comparison of two systems of cardiopulmonary bypass. Perfusion 2014; 30:389-94. [PMID: 25143413 DOI: 10.1177/0267659114548256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the influence of haemodilution, bypass flow rates and calculated oxygen delivery during cardiopulmonary bypass (CPB) with either a conventional CPB (C-CPB) circuit or a miniaturised (Mini-CPB) circuit on cerebral oxygen desaturation. The effect of minimal haemodilution with a Mini-CPB was investigated. PARTICIPANTS Eighty patients scheduled for elective cardiac surgery. INTERVENTION Oxygenated haemoglobin (O2Hb) and tissue oxygenation index (TOI) were measured with near-infrared spectroscopy (NIRS). RESULTS The average indexed bypass pump flow was significantly lower with Mini-CPB. When combined with haemoglobin concentration, the average oxygen delivery was the same between groups. Patients in the C-CPB group had a greater duration and severity of cerebral desaturation to a level <20% below baseline values, but none reached the depth and duration of the cerebral desaturation associated with poor outcome. Cerebral oxygen desaturation with C-CPB was significantly associated with low flows during bypass, whereas desaturation with Mini-CPB was associated with low perioperative haemoglobin concentration.
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Affiliation(s)
- M J Bennett
- Department of Cardiothoracic Anaesthesia, South West Cardiothoracic Centre, Plymouth, UK
| | - M Weatherall
- Department of Clinical Perfusion, South West Cardiothoracic Centre, Plymouth, UK
| | - G Webb
- Department of Clinical Perfusion, South West Cardiothoracic Centre, Plymouth, UK
| | - S F Dudnikov
- Department of Cardiothoracic Anaesthesia, South West Cardiothoracic Centre, Plymouth, UK
| | - C T Lloyd
- Department of Cardiac Surgery, South West Cardiothoracic Centre, Plymouth, UK
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Choi DK, Kim WJ, Chin JH, Lee EH, Don Hahm K, Yeon Sim J, Cheol Choi I. Intraoperative Renal Regional Oxygen Desaturation Can Be a Predictor for Acute Kidney Injury after Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 28:564-71. [DOI: 10.1053/j.jvca.2013.12.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Indexed: 01/09/2023]
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Nakazato T, Nakamura T, Sekiya N, Sawa Y. Preoperative Estimated Glomerular Filtration Rate is an Independent Predictor of Late Cardiovascular Morbidity after Mitral Valve Surgery. Ann Thorac Cardiovasc Surg 2014; 20:390-7. [DOI: 10.5761/atcs.oa.13-00187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Johansson M, Nozohoor S, Bjursten H, Kimblad PO, Sjögren J. Acute kidney injury assessed by cystatin C after transcatheter aortic valve implantation and late renal dysfunction. J Cardiothorac Vasc Anesth 2013; 28:960-5. [PMID: 24315756 DOI: 10.1053/j.jvca.2013.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate acute kidney injury (AKI) with cystatin C following transcatheter aortic valve implantation (TAVI) and to assess the impact of postoperative AKI on outcome and late renal function. DESIGN A prospective study. SETTING Single, tertiary referral center. PARTICIPANTS Sixty-eight consecutive patients with severe aortic stenosis and advanced comorbidity. INTERVENTIONS Blood samples were collected on 4 occasions pre- and postoperatively to determine levels of s-creatinine and cystatin C. Additionally, a sample was collected at followup 12 months postoperatively for the determination of s-creatinine. MEASUREMENTS AND MAIN RESULTS The mean preoperative eGFR (s-creatinine) was 67±24 mL/min/1.73 m² compared to 45±21 mL/min/1.73 m² with eGFR (cystatin C) (p<0.001). Postoperative AKI was diagnosed in 25 patients (39%) with eGFR (cystatin C), compared to 21 patients (33%) with GFR (s-creatinine) and the RIFLE criteria. The 90-day mortality was 14.3% for the AKI+group and 2.3% for the AKI-group (p = 0.099). At 12 months followup, renal function remained impaired in patients with postoperative AKI and deteriorated in patients without. CONCLUSIONS The risk of postoperative AKI is considerable following TAVI, with an increased risk of early mortality for AKI+patients. Cystatin C may be a valuable adjunct to the established biomarker s-creatinine for preoperative risk assessment and for early postoperative diagnosis of AKI. The acute postoperative renal impairment in patients with AKI does not fully recover in the long term. There is a progressive renal impairment in both groups postoperatively, the etiology probably being multifactorial.
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Affiliation(s)
- Malin Johansson
- Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden.
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Per Ola Kimblad
- Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
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Steinthorsdottir KJ, Kandler K, Agerlin Windeløv N, Steinbrüchel DA. Renal replacement therapy after cardiac surgery; renal function recovers. SCAND CARDIOVASC J 2013; 47:303-6. [PMID: 23915029 DOI: 10.3109/14017431.2013.821625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy. DESIGN In April 2012 we conducted a cross-sectional study of patients treated with renal replacement therapy following cardiac surgery during 2008-2010. We included all adult patients with a pre-operative serum creatinine (sCr) < 200 μM, surviving to discharge. Primary endpoint was use of renal replacement therapy after hospital discharge; secondary endpoint was a sCr > 200 μM at the time of follow-up. RESULTS We reviewed the records of 3828 patients receiving cardiac surgery in the defined period. A total of 107 adult patients with sCr concentrations < 200 μM were treated with post-operative renal replacement therapy of whom 70 survived to discharge. Fifty-six patients were alive at follow-up and none had required renal replacement therapy after initial discharge. Median sCr concentration at follow-up was 111 [56-257] μM and two patients had sCr above 200 μM. CONCLUSIONS In this study, renal function recovered in patients discharged from hospital following renal replacement therapy after CSA-AKI. No patients needed further renal replacement therapy and only two (4%) had a sCr > 200 μM at follow-up.
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Valentine E, Gregorits M, Gutsche JT, Al-Ghofaily L, Augoustides JG. Clinical Update in Liver Transplantation. J Cardiothorac Vasc Anesth 2013; 27:809-15. [DOI: 10.1053/j.jvca.2013.03.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Indexed: 02/08/2023]
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Akkucuk FG, Kanbak M, Ayhan B, Celebioglu B, Aypar U. The Effect of HES (130/0.4) Usage as the Priming Solution on Renal Function in Children Undergoing Cardiac Surgery. Ren Fail 2012; 35:210-5. [DOI: 10.3109/0886022x.2012.747139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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