Abstract
BackgroundAcute kidney injury (AKI) is a frequent and serious complication of cardiac surgery, associated with a high incidence of morbidity and mortality. Although the RIFLE criteria serve as a prominent tool to identify patients at high risk of AKI, an optimized diagnosis model in clinical practice is desired.MethodsBased on the SOP-criteria, 365 patients (10%) developed AKI following surgery and were subjected to RRT. In contrast, the incidence of AKI, defined according to the RIFLE criteria, was only 7% (n = 251 patients). Prominent risk factors identified by SOP were patients’ sex, valve and combined valve and bypass surgery, deep hypothermia, use of intra-aortic balloon pump (IABP) and previous coronary interventions. Ischemia, reperfusion, blood loss and surgery time also served as significant risk factors for patient evaluated by SOP.ResultsRisk assessment by RIFLE differed in as much as most patients with normothermia and those receiving only cardiovascular bypass developed AKI. However, patients’ sex and valve surgery did not serve as a risk factor.ConclusionEvaluation of patients by the RIFLE versus SOP criteria yielded different results with more AKI patients detected by SOP. Based on the present data, it is concluded that patients may not prone to AKI when surgery and ischemia time will be kept short, when blood loss is mitigated to a minimum and when surgery is performed under non-hypothermic conditions.
Highlights
The development of the heart-lung machine has revolutionized cardiac surgery
Cardiovascular surgery is associated with severe complications, whereby acute kidney injury (AKI) has been linked with a high incidence of morbidity and mortality [1]. 2–5% of patients developing AKI after cardiac surgery require renal replacement therapy (RRT) that may further increase mortality [2]
Acute kidney injury Patients were divided into two groups, cohort 1 with normal renal function post-surgery and cohort 2 who developed acute kidney injury (AKI) and was subjected to renal replacement therapy (RRT) done by continuous veno-venous hemodialysis (CVVH; multiFiltrate, Fresenius Medical Care, Bad Homburg, Germany)
Summary
The development of the heart-lung machine has revolutionized cardiac surgery. Still, cardiovascular surgery is associated with severe complications, whereby acute kidney injury (AKI) has been linked with a high incidence of morbidity and mortality [1]. 2–5% of patients developing AKI after cardiac surgery require renal replacement therapy (RRT) that may further increase mortality [2].The percentage of the AKI rates vary depending on the study populations and the AKI definitions. Cardiovascular surgery is associated with severe complications, whereby acute kidney injury (AKI) has been linked with a high incidence of morbidity and mortality [1]. Hu and colleagues using either the RIFLE (Risk, Injury, Failure, Loss, End-Stage Renal Disease, based on serum creatinine, urine output and/or glomerular filtration rate, GFR), AKIN (Acute Kidney Injury Network, based on serum creatinine and not on GFR changes), or KDIGO (Kidney Disease: Improving Global Outcomes) criteria (combining the differences between the RIFLE and AKIN) have estimated a global incidence of AKI after cardiac surgery at 22.3% [1]. Acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery, associated with a high incidence of morbidity and mortality. The RIFLE criteria serve as a prominent tool to identify patients at high risk of AKI, an optimized diagnosis model in clinical practice is desired
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