Definition of Acute Renal Injury with RIFLE Classification That Occurs After Coronary Bypass Surgery: Risk Markers and Results

Year 2019, , 463 - 469, 25.12.2019

Mehmet Erin Tüysüz , Mehmet Dedemoğlu

https://doi.org/10.35440/hutfd.594147

Abstract

Background:To
define acute kidney injury (AKI) that develops following coronary artery bypass
grafting (CABG) surgery using RIFLE classification system and to determine the
risk factors affecting the early and late mortality of the patients who
developed acute kidney injury.

Materials and Methods: A
total of 213 patients who underwent isolated CABG operation in our clinic
between February 2016 and September 2018 were retrospectively investigated.
Preoperative and postoperative estimated glomerular filtration rates were calculated
for all patients. The diagnosis and severity of AKI was determined by RIFLE
classification.

Results: The median age of
the patients included in the study was 62, of whom 114 were male. In the
postoperative period, AKI was detected in 65 (30.5%) patients according to
RIFLE classification. 63.1 % of the patients were in stage R, 23.1 % were in
stage I, 13.8 % were in stage F.  L and E
stages of AKI did not develop in any patients. Comorbid conditions such as diabetes
mellitus, hypertension, congestive heart failure and peripheral artery disease,
and the duration of cardiopulmonary bypass (CPB) were detected to be
independent risk factors for the development of AKI. Bleeding revision need for
hemodialysis, usage of intra aortic balloon pump and respiratory complications
were higher in the AKI group than in the non-AKI group. In addition,
in-hospital and long term mortality rates were significantly higher in AKI
group. As the severity of AKI increased, the survival rates of the patients
were decreased. The patients in stage –F had the lowest survival rate.

Conclusion: RIFLE
classification is a low-cost and easy-to-use tool to detect AKI developing
after CABG surgery and it helps to detect kidney injury at the initial stage.
This classification provides a prediction about the mortality and morbidity of
the patients who developed AKI following CABG surgery.

Koroner Bypass Greftleme Cerrahisi Sonrası Gelişen Akut Böbrek Hasarının RIFLE Sınıflamasıyla Tanımlanması: Risk Belirteçleri ve Sonuçları

Abstract

Amaç: RIFLE
sınıflamasını kullanarak Koroner arter bypass greftleme (KABG) cerrahisi
sonrasında gelişen akut böbrek hasarını (ABH) tanımlamak, hasar gelişmiş
hastaların erken ve geç dönem mortalitelerine etki eden risk faktörlerini
belirlemektir.

Materyal ve Metod: Kliniğimizde
Şubat 2016 ile Eylül 2018 yılları arasında izole KABG operasyonu yapılan 213
hasta geriye dönük olarak incelendi. Tüm hastaların operasyon öncesi ve sonrası
tahmini glomeruler filtrasyon hızları hesaplandı. ABH’nin tanısı ve ciddiyeti,
RIFLE sınıflaması ile belirlendi. 

 

Bulgular: Çalışmaya
dâhil edilen hastaların medyan yaşı 62 yıldı, hastaların 144’ü (%67,6)
erkekti.  Postoperatif dönemde, RIFLE
sınıflamasına göre 65 (%30,5) hastada ABH saptandı.  Hastaların %63,1’i evre R, %23,1’i evre I,
%13,8’i ise F evresindeydi. ABH’nin L ve E evresi hiçbir hastada gelişmedi.
Diyabetes mellitus, hipertansiyon, konjestif kalp yetmezliği, periferik arter
hastalığı gibi komorbid faktörler ve kardiyopulmoner bypass (KPB) süresi ABH
gelişiminde bağımsız risk faktörleri olarak saptandı. ABH bulunan grupta ABH
bulunmayan gruba göre post operatif dönemde kanama revizyonu, hemodiyaliz
ihtiyacı, intraaortik balon pompası kullanımı ve solunumsal komplikasyonlar
daha fazlaydı. Ek olarak, hastane içi ve geç dönem mortalite oranları ABH olan
grupta daha yüksekti. Hastaların sağkalım oranları ABH’nin ciddiyeti arttıkça
düştü. Evre F’deki hastalar en düşük sağkalım oranına sahipti.

Sonuç: RIFLE
sınıflaması, KABG cerrahisi sonrası gelişen ABH’yi gösteren maliyeti düşük ve
kolay uygulanabilir bir araçtır ve böbrek hasarının başlangıç evresinde
saptanmasına yardımcı olur. Bu sınıflama, KABG cerrahisi sonrası ABH gelişen
hastaların mortalite ve morbiditesi hakkında öngörü sağlar.

Keywords

Akut böbrek hasarı, koroner arter bypass greftleme

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