Predictors of acute kidney injury in patients undergoing adult cardiac surgery

• Main Authors: Sreja Gangadharan, K R Sundaram, Senthilvelan Vasudevan, B Ananthakrishnan, Rakhi Balachandran, Abraham Cherian, Praveen Kerala Varma, Luis Bakero Gracia, K Murukan, Ashish Madaiker, Rajesh Jose, Rakesh Seetharaman, Kirun Gopal, Sujatha Menon, M Thushara, Reshmi Liza Jose, G Deepak, Sudheer Babu Vanga, Aveek Jayant
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Annals of Cardiac Anaesthesia
• Subjects: Acute kidney injury; acute kidney injury network criteria; cardiac surgery; mortality; renal failure requiring dialysis; risk stratification
• Online Access: http://www.annals.in/article.asp?issn=0971-9784;year=2018;volume=21;issue=4;spage=448;epage=454;aulast=Gangadharan

Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.