Abstract
IntroductionPostoperative acute kidney injury contributes to longer hospital stays and increased costs related to cardiac surgery in the elderly. We analyse the influence of the patient’s age on risk factors for acute kidney injury after cardiac valve surgery.MethodsWe evaluated the prevalence and risk factors for acute kidney injury in 939 consecutive patients undergoing valve surgery, between 2013 and 2018.ResultsThe prevalence of acute kidney injury was 19.5%. Hypertension (P=0.017); RR (95% CI): 1.74 (1.10-3.48), age ≥70 years (P=0.006); RR (95% CI): 1.79 (1.17-2.72), preoperative haematocrit <33% (P=0.009); RR (95% CI): 2.04 (1.19-3.48), glomerular filtration rate <60 ml/min/1.73 m2 (P<0.0001); RR (95%) CI: 2.36 (1.54-3.62) and cardiac catheterization <8 days before surgery (P=0.021); RR (95% CI): 2.15 (1.12-4.11) were identified as independent risk factors. In patients older than 70 years, with no kidney disease diagnosed preoperatively, glomerular filtration rate <70 ml/min/1.73 m2, male gender, cardiopulmonary bypass time, preoperative haematocrit <36% and preoperative therapy with angiotensin-converting enzyme inhibitors were risk factors for acute kidney injury after valve surgery.ConclusionsIn elderly patients, postoperative acute kidney injury develops with higher values of preoperative glomerular filtration rate than those observed in a younger population. Preoperative correction of anaemia, discontinuation of angiotensin-converting enzyme inhibitors and surgical techniques reducing cardiopulmonary bypass time would be considered to reduce the prevalence of renal failure.
Highlights
Postoperative acute kidney injury contributes to longer hospital stays and increased costs related to cardiac surgery in the elderly
We evaluated the prevalence and risk factors for acute kidney injury in 939 consecutive patients undergoing valve surgery, between 2013 and 2018
Hypertension (P=0.017); RR: 1.74 (1.10-3.48), age ≥70 years (P=0.006); RR: 1.79 (1.17-2.72), preoperative haematocrit
Summary
Postoperative acute kidney injury contributes to longer hospital stays and increased costs related to cardiac surgery in the elderly. We analyse the influence of the patient’s age on risk factors for acute kidney injury after cardiac valve surgery. Postoperative acute kidney injury (AKI) is a known complication after cardiac surgery under cardiopulmonary bypass (CPB). The loss of pulsatility flow, kidney injury related to ischemia and reperfusion, haemolysis, inflammatory response activation, vascular redistribution and embolic phenomena are some of the factors involved in its appearance. Risk factors related to the patient (such as age and preoperative renal failure) increase the probability of the development of AKI. The prevalence of AKI after CPB ranges between 28 and 94% of patients.
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