What are the factors affecting the progression of kidney failure, mortality and morbidity after cardiac surgery in patients with chronic kidney disease?

Abstract

Acute kidney injury occurs in as many as 40% of patients after cardiac surgery and requires dialysis in 1% of cases and associated with an increased risk of mortality and morbidity, predisposes patients to a longer hospitalization, requires additional treatments, and increases the hospital costs. We aimed to investigate the factors affecting the progression of kidney disease during cardiac surgery in preoperative chronic kidney disease patients (CKD). The demographic data of patients and preoperatively studied parameters are: American Society of Anesthesiologists Classification, diabetes mellitus, hypertension, left ventricular ejection fractions, estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. The pre and postoperative parameters recorded were glucose, blood urea nitrogen (BUN), creatinine, hemoglobin, and eGFR. In the intensive care follow-up, discharge status, revision status and 30-day mortality rates and complications were analyzed. One hundred and thirty-eight patients (87 males, 51 females; mean age 61.7 years) were included, the mean preoperative Euro score II value was 8.72 ± 7.09 (7.3 ± 6.2 in the survival group and 13.1 ± 7.9. 83 in the deceased group). The number of patients who underwent revision surgery due to postoperative bleeding were 36 (26.09%) and the 30-day surgical mortality was 24.64% (n = 34). Age, complication, euro score, cross-clamp time, pulmonary artery pressure, postoperative BUN, creatine, and CKD-EPI-GFR were found to be significantly effective in predicting 30-day mortality of the patients.