Abstract
BackgroundAtherosclerotic renal artery stenosis (ARAS) and coronary artery disease (CAD) commonly co-exist. Some patients with unidentified ARAS may undergo cardiac surgery. While acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery, we aim to evaluate the influence of ARAS on the occurrence of postoperative AKI in patients with normal or near-normal baseline renal function following cardiac surgery.MethodsA total of 212 consecutive patients undergoing aortography after coronary angiography and cardiac surgery were retrospectively studied for their preoperative and intraoperative conditions. AKI was defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg/dl (≥26.4 µmol/l) or a percentage increase in creatinine of more than or equal to 50% (1.5-fold from baseline) after cardiac surgery. A propensity score-adjusted logistic regression models was used in estimating the effect of ARAS on the risk of postoperative AKI.ResultsARAS (≥50%) was observed in 50 (23.6%) patients, and 83 (39.2%) developed AKI after cardiac surgery. A correlation existed between renal artery patency and preoperative–to–postoperative %ΔCr in patients with ARAS (r = 0.297, P<0.0001). The propensity score-adjusted regression model showed the occurrence of postoperative AKI in patients with ARAS was significantly higher than those without ARAS (OR 2.858, 95% CI 1.260–6.480, P = 0.011).ConclusionARAS is associated with postoperative AKI in patients with normal or near-normal baseline renal function after cardiac surgery.
Highlights
Acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery
[20] acute kidney injury (AKI) was defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg/dl ($26.4 mmol/l) or a percentage increase in creatinine of more than or equal to 50% (1.5-fold from baseline) after cardiac surgery [21]
Our study demonstrated that Atherosclerotic renal artery stenosis (ARAS) was associated with AKI after cardiac surgery, independent of the use of cardiopulmonary bypass (CPB)
Summary
Acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery. The incidence of AKI following cardiac surgery has been reported to vary between 1% and 30%, depending on the criteria used to define the complication. [1,2,3] AKI is an independent predictor for short- and long-term morbidity and in-hospital mortality, with a two fold to three fold increase in risk. [4] The etiology of AKI following cardiac surgery is poorly understood, but it is believed that ischemic injury of the kidneys, resulted from inadequate perfusion, is a major factor. There was a case report that renal angioplasty prior to coronary surgery, in patients with concomitant renal and coronary artery disease, may reduce perioperative kidney injury, [16] while Conlon PJ et al [17] showed renal artery stenosis was not associated with the development of acute renal failure following CABG. They did find carotid artery bruit, a form of peripheral artery disease, was a risk factor of acute renal failure following CABG. While acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery, we aim to evaluate the influence of ARAS on the occurrence of postoperative AKI in patients with normal or near-normal baseline renal function following cardiac surgery
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