Impact of cardiac catheterization timing and contrast media dose on acute kidney injury after cardiac surgery

Wuhua Jiang,Zhe Luo,Jie Teng,Chunsheng Wang,Jiawei Yu,Bo Shen,Jiarui Xu,Yimei Wang,Xiaoqiang Ding

doi:10.1186/s12872-018-0928-8

Abstract

BackgroundThe association between pre-operative cardiac catheterization and cardiac surgery associated acute kidney injury (CSA-AKI) has been reported inconsistently. The purpose of this study is to evaluate the effect of the catheterization timing and contrast media dose on the incidence of postoperative acute kidney injury.MethodsPatients who underwent cardiac catheterization and cardiac surgery successively from January 2015 to December 2015 were prospectively enrolled in this study. The primary outcome was CSA-AKI which was defined as the Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO) criteria. Univariate analysis and multivariate regression were performed to identify the predictors for CSA-AKI. Baseline characteristics were balanced with propensity score method for better adjustment.ResultsA total of 1069 consecutive eligible patients were enrolled into this study. The incidence of CSA-AKI and AKI requiring renal replacement therapy (AKI-RRT) were 38.5% (412/1069) and 1.9% (20/1069) respectively. Preoperative estimated glomerular filtration rate less than 60 mL/min/1.73m2 (OR = 2.843 95% CI 1.374–5.882), the time interval between catheterization and surgery≤7 days (OR = 2.546, 95% CI 1.548–4.189) and the dose of contrast media (CM) > 240 mg/kg (OR = 2.490, 95%CI 1.392–4.457) were identified as predictors for CSA-AKI. In the patients with the dose of CM > 240 mg/kg, the incidence of CSA-AKI was higher in patients who underwent cardiac catheterization ≤7 days before cardiac surgery than in those of > 7 days before cardiac surgery (39.4% vs. 28.8%, p = 0.025). The longer interval of more than 7 days was revealed to be inversely associated with CSA-AKI through logistic regression (OR = 0.579, 95% CI 0.337–0.994).ConclusionCatheterization within 7 days of cardiac surgery and a dose of CM > 240 mg/kg were associated with the onset of CSA-AKI. For patients who received a dose of CM > 240 mg/kg, postponing the cardiac surgery is potentially beneficial to reduce the risk of CSA-AKI.

Highlights

The association between pre-operative cardiac catheterization and cardiac surgery associated acute kidney injury (CSA-Acute kidney injury (AKI)) has been reported inconsistently
The main findings of current study are (1) AKI after catheterization and cardiac surgery is prevalent, according to KDIGO definition, with the incidence of 38.5%; (2) the mortality of patients with AKI is significantly higher than those without AKI; (3) lower baseline estimated glomerular filtration rate (eGFR), shorter interval between catheterization and cardiac surgery(< 7 days) and higher contrast media (CM) dose(> 240 mg/kg) used are associated with the development of cardiac surgery associated acute kidney injury (CSA-AKI); (4) in the patients receiving higher dose of CM, postponing cardiac surgery is possibly protective for reducing AKI risk
The current study showed catheterization within 7 days of cardiac surgery, a dose of contrast media over 240 mg/kg and preoperative eGFR less than 60 ml/min/ 1.73m2 were associated with increased risk of CSA-AKI

Summary

Introduction

The association between pre-operative cardiac catheterization and cardiac surgery associated acute kidney injury (CSA-AKI) has been reported inconsistently. The purpose of this study is to evaluate the effect of the catheterization timing and contrast media dose on the incidence of postoperative acute kidney injury. Since no effective therapy is available to reverse the mechanism of AKI, Cardiac catheterization is one of the common pre-operative examinations This procedure is aimed to screen the patients with high risk of coronary artery disease and provide clinicians with multiple cardiac surgical procedure alternatives. The association between pre-operative cardiac catheterization and postoperative acute kidney injury has been reported in several studies [6,7,8,9,10,11]. Jiang et al BMC Cardiovascular Disorders (2018) 18:191 dose of contrast media (CM) simultaneously [11]

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