Risk factor for acute kidney injury in patients with chronic kidney disease receiving valve surgery with cardiopulmonary bypass

Introduction: Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) in patients with pre-existing impaired renal function carries deleterious outcomes but is not frequently evaluated. The optimal CPB strategy for preventing AKI in this vulnerable patient group is still controversial. Methods: A total of 156 patients with preoperative estimated glomerular filtration rate (e-GFR) <30 ml/ min but not on chronic dialysis receiving valve operation under CPB were included in the present study. Postoperative AKI was defined as KDIGO (Kidney Disease Improving Global Outcomes) stage 3. Hospital mortality and two-year renal function evolution were compared between patients with postoperative AKI and those without AKI. Risk factors for the development of postoperative AKI were also studied. Results: The incidence of postoperative KDIGO-3 was high (44.2%). Hospital mortality was higher in the AKI group (30.4%) than in the non-AKI group (8.0%). Among the hospital survivors, renal function deterioration to permanent dialysis at two years was also more common in AKI group (14.5%) than in non-AKI group (4.6%). Univariate logistic regression for postoperative AKI revealed male gender, increased age, height, weight, BSA, and BMI, high preoperative serum creatinine, prolonged CPB duration, and decreased CPB target temperature as risk factors. However, multivariate analysis revealed only high preoperative serum creatinine and decreased CPB target temperature as significant risk factors for postoperative AKI. Conclusion: To prevent postoperative AKI in CKD patients, low CPB target temperature is avoided, especially for those with high preoperative serum creatinine levels. (C) 2020 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.

Automated summary

This study found a high incidence of postoperative AKI in patients with pre-existing impaired renal function, which was associated with high preoperative serum creatinine levels and decreased CPB target temperature. AKI patients had higher hospital mortality and a worse two-year renal function evolution compared to non-AKI patients.