Abstract
Patients undergoing coronary artery bypass grafting (CABG) are at risk of developing postoperative renal impairment, amongst others caused by renal ischemia and hypoxia. Intra-operative monitoring of renal region tissue oxygenation (SrtO2) might be a useful tool to detect renal hypoxia and predict postoperative renal impairment. Therefore, the aim of this study was to assess the ability of intra-operative SrtO2 to predict postoperative renal impairment, defined as an increase of serum creatinine concentrations of > 10% from individual baseline, and compare this with the predictive abilities of peripheral and cerebral tissue oxygenation (SptO2 and SctO2, respectively) and renal specific tissue deoxygenation. Forty-one patients undergoing elective CABG were included. Near-infrared spectroscopy (NIRS) was used to measure renal region, peripheral (thenar muscle) and cerebral tissue oxygenation during surgery. Renal region specific tissue deoxygenation was defined as a proportionally larger decrease in SrtO2 than SptO2. ROC analyses were used to compare predictive abilities. We did not observe an association between tissue oxygenation measured in the renal region and cerebral oxygenation and postoperative renal impairment in this small retrospective study. In contrast, SptO2 decrease > 10% from baseline was a reasonable predictor with an AUROC of 0.767 (95%CI 0.619 to 0.14; p = 0.010). Tissue oxygenation of the renal region, although non-invasively and continuously available, cannot be used in adults to predict postoperative renal impairment after CABG. Instead, peripheral tissue deoxygenation was able to predict postoperative renal impairment, suggesting that SptO2 provides a better indication of ‘general’ tissue oxygenation status.Registered at ClinicalTrials.gov: NCT01347827, first submitted April 27, 2011.
Highlights
Cardiac surgery is often complicated by acute kidney injury (AKI)
Data were obtained in 59 patients who were randomized to on-pump or off-pump coronary artery bypass grafting (CABG) and who had near-infrared spectroscopy (NIRS) sensors applied at the flank, the thenar muscle, and the forehead to measure renal region, peripheral, and cerebral tissue oxygenation, respectively
We did not observe an association between tissue oxygenation measured in the renal region or cerebral oxygenation and postoperative renal impairment in this small retrospective study
Summary
The incidence of AKI after cardiac surgery, as identified by commonly used AKI classification systems (AKIN, KDIGO, or RIFLE) varies from 5 to 42% depending on comorbidity, surgical technique, and the population studied [1, 2]. AKI classifications—is associated with increased postoperative morbidity and mortality after cardiac surgery [3, 4]. In the time since the AKI classifications have become widely accepted, studies have been published that suggest that smaller changes in serum creatinine should not be ignored [5, 6]. It has been advocated that impaired postoperative renal function is best evaluated as an increase of postoperative serum creatinine levels compared to individual preoperative levels [4, 7]. Intra-operative tissue oxygenation measured in the renal region (SrtO2) offers a non-invasive dynamic insight into tissue oxygenation, by
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