Cardiac Surgery - Related Acute Kidney Injury _ Risk Factors, Clinical Course, Management Suggestions

Objective: Acute kidney injury (AKI) is a common complication after cardiac surgery (CS). Because a therapeutic regimen remains scarce, the early implementation of preventive strategies is crucial. The authors investigated risk factors and the typical clinical course of CS-associated AKI (CS-AKI) to derive strategies for perioperative clinical routines. Design: Retrospective data analysis. Setting: The data were collected from clinical routines in a maximum care university hospital. Participants: Patients. Interventions: The authors retrospectively analyzed data from 538 patients who underwent CS. Measurements and Main Results: The median age of the 466 patients included was 66.6 years; 65.7% were men. AKI occurred in 131 (28.1%) patients, mainly (89.0%) starting postoperatively within 72 hours p. Thirty-one (6.7%) patients showed Kidney Disease Improving Global Out-come AKI stage 3. AKI was significantly more frequent in patients with chronic kidney disease (p < 0.001), emergency admission (p < 0.001), heart failure (p < 0.001), and postoperative complications (p < 0.001). In a multivariate analysis, postoperative CS-AKI risk significantly decreased with each 1 or 10 mL/min preoperative glomerular filtration rate (GFR) (odds ratio, 0.962 and 0.677; 95% confidence interval, 0.947-0.977 and 0.577-0.793; p < 0.001 and p < 0.0001). Only in patients who developed Kidney Disease Improving Global Outcome AKI stage 3, an early postoperative trend to decreased GFR and increased creatinine levels was observed. Conclusions: Especially in patients with preexisting CKD and signs of CS-AKI occurring on the day of surgery, close monitoring of renal func-tion should be performed for at least 72 hours after CS to detect an onset of AKI early and initiate renal protective strategies. Optimal preopera-tive fluid management might prevent postoperative AKI. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

This study aimed to investigate the risk factors and typical clinical course of cardiac surgery-associated acute kidney injury (CS-AKI) and derive strategies for perioperative clinical routines. The results showed that close monitoring of renal function for at least 72 hours after cardiac surgery is crucial, especially in patients with preexisting chronic kidney disease (CKD) and signs of CS-AKI. Renal protective strategies should be initiated early to prevent the onset of AKI.