Analysis of the Incidence and Risk Factors in the Development of Acute Kidney Injury after Off Pump Coronary Artery Bypass Grafting

Authors

  • Jose Perumpillil Paul Assistant Professor, Department of Nephrology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. Author
  • Nageswara Reddy Pamidi Assistant Professor, Department of Nephrology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. Author
  • G Suresh Kumar Assistant Professor, Department of Nephrology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. Author
  • K Sharath Kumar Reddy Assistant Professor, Department of Nephrology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. Author

Keywords:

Acute kidney injury, Coronary artery disease, Graft

Abstract

Background: Acute kidney injury (AKI) is a serious complication after coronary artery bypass grafting and is associated with a high mortality. The aim of this study was to evaluate the incidence and the risk factors involved in the development of AKI after off pump coronary artery bypass grafting (OPCAB). Subjects and Methods: A retrospective analysis of 1378 adult patients who underwent OPCAB in Sapthagiri Institute of Medical Sciences and Research Centre during a one-and-a-half-year period was done. AKI was defined as an increase in creatinine more than 0.3 mg/dl or a decrease in urine output less than 0.5 ml.kg.hr for 6 hrs. The data relevant to the risk factors were collected and analysed using chi square test. Results: The overall incidence of AKI was 18.2%. The independent risk factors that were associated with AKI were increasing age, pre-operative chronic kidney disease, diabetes mellitus, left ventricular dysfunction, low mean arterial blood pressure and the need for intra-aortic balloon pump. Conclusion: AKI was common after OPCAB. Pre-existing renal dysfunction, diabetes mellitus, left ventricular dysfunction, advanced age, low mean arterial blood pressure during the intra operative period and the need for intra-aortic balloon pump were identified as the risk factors for the development of AKI after OPCAB. 

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References

Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients. J Am Soc Nephrol. 2005;16(11):3365–3370. Available from: https://dx.doi.org/10. 1681/asn.2004090740.

2. Loef BG, Epema AH, Smilde TD, Henning RH, Ebels T, Navis G, et al. Immediate Postoperative Renal Function Deterioration in Cardiac Surgical Patients Predicts In-Hospital Mortality and Long-Term Survival. J Am Soc Nephrol. 2005;16(1):195–200. Available from: https://dx.doi.org/10.1681/asn.2003100875.

3. Mangano CM, Stone LSD, Ramsay JG, Aggarwal A, Herskow itza M. Renal dysfunction after myocardial revascularization: Risk factors, adverse out comes, and hospital resource utiliza tion. The Multicenter Study of Preoperative Ischemia Research Group. Ann Intern Med. 1998;128:194–203. Available from: https://doi.org/10.7326/0003-4819-128-3-199802010-00005.

4. Rosner MH, Okusa MD. Acute Kidney Injury Associated with Cardiac Surgery. Clin J Am Soc Nephrol. 2006;1(1):19–32. Available from: https://dx.doi.org/10.2215/cjn.00240605.

5. Lassingg A, Schmidlin D, Mouhieddine M. Minimal changes in serumcreatinine predict prognosis in patients after cardio thoracic surgery: aprospective cohort study. J Am Soc Nephrol. 2004;15(6):1597–1605. Available from: https://doi.org/10. 1097/01.asn.0000130340.93930.dd.

6. Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysis. Am J Kidney Dis. 2009;53(6):961–973. Available from: https: //dx.doi.org/10.1053/j.ajkd.2008.11.034.

7. Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet. 2012;380:756–766. Available from: https://dx.doi.org/ 10.1016/s0140-6736(11)61454-2.

8. Abuelo JG. Normotensive Ischemic Acute Renal Failure. N Engl J Med. 2007;357(8):797–805. Available from: https: //dx.doi.org/10.1056/nejmra064398.

9. Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Investig. 2004;114:5–14. Available from: https://dx.doi.org/10. 1172/jci200422353.

10. Bruinsp, Yazdanbakhshap, Jansenpg, Beaumont EM. Acti vation of the complement system during and after cardiopul monary bypass surgery: post-surgery activation involves c

reactive protein and is associated with postoperative arrhyth mia. Circulation. 1997;96(10):3542–3550. Available from: https://doi.org/10.1161/01.cir.96.10.3542.

11. Sun S, Ma F, Li Q, Bai M, Li Y, Yu Y, et al. Risk modelfordeathsandrenal replacement therapy dependence in patients with acute kidney injury aftercardiacsurgery. Interact Cardiovasc Thorac Surg. 2017;25(4):548–554. Available from: https://doi.org/10.1093/icvts/ivx210.

12. Palevsky PM. Renal Replacement Therapy in Acute Kidney Injury. Adv Chronic Kidney Dis. 2013;20(1):76–84. Available from: https://dx.doi.org/10.1053/j.ackd.2012.09.004.

13. O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 2016;20(1):187. Available from: https: //dx.doi.org/10.1186/s13054-016-1352-z.

14. Meersch M, Schmidt C, Zarbock A. Perioperative Acute Kid ney Injury. Anesth Analg. 2017;125(4):1223–1232. Available from: https://dx.doi.org/10.1213/ane.0000000000002369.

15. Mao H, Katz N, Ariyanon W, Blanca-Martos L, Adýbelli Z, Giuliani A, et al. Cardiac Surgery-Associated Acute Kidney Injury. Blood Purif. 2014;37(2):34–50. Available from: https: //dx.doi.org/10.1159/000361062.

16. Yuan SM. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol. 2019;60(1):3–11. Available from: https://doi. org/10.1016/j.pedneo.2018.03.007.

17. Obialo C. Acute kidney injury following cardiopulmonary bypass surgery. Niger J Cardiovasc Thorac Surg. 2017;2(1):3. Available from: https://dx.doi.org/10.4103/njct.njct_1_17.

18. Palomba H, de Castro I, Neto ALC, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney Int. 2007;72(5):624–631. Available from: https://dx.doi.org/10.1038/sj.ki.5002419.

19. Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009;119(4):495–502. Available from: https://doi.org/10. 1161/circulationaha.108.786913.

20. Massoudy P, Wagner S, Thielmann M, Herold U, Kottenberg Assenmacher E, Marggraf G, et al. Coronary artery bypass surgery and acute kidney injury–impact of the off-pump technique. Nephrol Dial Transplant. 2008;23(9):2853–2860. Available from: https://dx.doi.org/10.1093/ndt/gfn153.

21. Chertow GM, Lazarus JM, Christiansen CL, Cook EF, Hammermeister KE, Grover F, et al. Preoperative Renal Risk Stratification. Circulation. 1997;95(4):878–884. Available from: https://dx.doi.org/10.1161/01.cir.95.4.878.

22. Provenchere S, Plantefeve G, Hufnagel G. Renal dysfunction after cardiac surgery with normothermic cardiopulmonary bypass: Incidence, risk factors, and effect on clinical outcome. Anesth Analg. 2003;96:1258–1264. Available from: https: //doi.org/10.1213/01.ane.0000055803.92191.69.

23. Kinoshita T, Asai T, Murakami Y, Suzuki T, Kambara A, Matsubayashi K. Preoperative Renal Dysfunction and

Mortality After Off-Pump Coronary Artery Bypass Grafting in Japanese. Circulation. 2010;74(9):1866–1872. Available from: https://dx.doi.org/10.1253/circj.cj-10-0312.

24. Harky A, Joshi M, Gupta S, Teoh WY, Gatta F, Snosi M. Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review. Braz J Cardiovasc Surg. 2020;35(2):211–235. Available from: https://dx.doi.org/10. 21470/1678-9741-2019-0122.

25. Stafford-Smith M, Li YJ, Mathew JP, Li YW, Ji Y, Phillips Bute BG. Genome-wide association study of acute kidney injury after coronary bypass graft surgery identifies suscepti bility loci. Kidney Int. 2015;88(4):823–855. Available from: https://doi.org/10.1038/ki.2015.161.

26. Liu Y, Li H, Chen S, Chen J, Tan N, Zhou Y. Excessively high hydration volume may not be associated with decreased risk of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with renal insufficiency. J Am Heart Assoc. 2016;5(6):003171. Available from: https: //doi.org/10.1161/jaha.115.003171.

27. Cheungpasitporn W, Thongprayoon C, Kittanamongkolchai W, Srivali N, O'corragain OA, Edmonds PJ. Comparison of renal outcomes in off-pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of randomized controlled trials. Nephrology (Carlton). 2015;20(10):727–762. Available from: https://doi.org/10. 1111/nep.12506.

28. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med. 2012;366(16):1489–1497. Available from: https://doi.org/10.1056/nejmoa1200388.

29. Pleština S, Gamulin S. Kidney Ischaemia-Reperfusion Injury and Polyribosome Structure. Nephron. 2001;89(2):201–207. Available from: https://dx.doi.org/10.1159/000046068.

30. Khan UA, Coca SG, Hong K, Koyner JL, Garg AX, Passik CS. Blood transfusions are associated with urinary biomarkers of kidney injury in cardiac surgery. J Thorac Cardiovasc Surg. 2014;148(2):726–732. Available from: https://dx.doi.org/10. 1016/j.jtcvs.2013.09.080.

Published

2021-06-25

How to Cite

Analysis of the Incidence and Risk Factors in the Development of Acute Kidney Injury after Off Pump Coronary Artery Bypass Grafting . (2021). Academia Journal of Medicine, 4(1), 68-73. https://medjournal.co.in/index.php/ajm/article/view/99