Frequency and factors affecting the development of acute kidney injury following open heart surgery

Abstract

Aim: Acute kidney injury after cardiac surgery (CSA-AKI) is one of the most common complications in adult patients and associated with high mortality and morbidity. We aimed to evaluate the factors affecting the development of postoperative acute kidney injury, and frequency of hemodialysis in patients with normal preoperative renal function tests, and those with high preoperative renal function tests but no need of dialysis.
Methods: Patients who underwent elective coronary artery bypass, valve surgery, or both surgeries in the Department of Thoracic and Cardiovascular Surgery of the university hospital between January 2009 and December 2009 were retrospectively examined in this cohort study. Preoperative data such as age, gender, body mass index, previous cardiac surgery, history of unstable angina, myocardial infarction and cardiogenic shock, preoperative drug use, history of comorbid diseases, left ventricular ejection fraction (%), intraoperative data such as type of surgery, the total time of surgery and cross-clamping time, postoperative data such as length of hospital and intensive care stay, the requirement of revision surgery and hemodialysis and mortality rates were recorded retrospectively.
Results: Advanced age, long surgery and cross-clamp times were risk factors for CSA-AKI (P=0.002, P=0.03, P=0.02). There was no difference between the groups in terms of previous cardiac surgery, gender, left ventricular ejection fraction, preoperative nephrotoxic drug use and surgery type (P=0.69, P=0.10, P=0.19, P=0.66, P=0.86). The length of hospital and intensive care stay of patients with acute renal failure was longer (P=0.001, P=0.001). The requirement of hemodialysis after surgery was 1.3%, and mortality rate was 2%.
Conclusion: We think that thorough examination of the patients who are at risk for CSA-AKI during the preoperative period and planning the optimal treatment will aid in decreasing postoperative mortality and morbidity. 

Keywords

• Acute Kidney Injury,Cardiac Surgical Procedures,Risk factors

Açık kalp cerrahisi sonrası akut böbrek yetmezliği gelişme sıklığı ve akut böbrek yetmezliği gelişmesine etki eden faktörler

Öz

Amaç: Açık kalp cerrahisi geçirecek yetişkin hastalarda, kardiyak cerrahi ilişkili böbrek hasarı gelişmesi en yaygın komplikasyonlardan biridir ve bu durum yüksek mortalite ve morbidite ile ilişkilendirilmektedir. Kardiyak cerrahi sonrası akut böbrek yetmezliği sıklığı, akut böbrek yetmezliğine, kronik böbrek hasarı üzerine gelişen akut böbrek yetmezliğine yol açan faktörler ve hemodiyaliz gereksinim sıklığının saptanması amaçlanmıştır.
Yöntemler: Üniversite hastanesi Göğüs Kalp Damar Cerrahisi Anabilim Dalı’nda Ocak 2009 ile Aralık 2009 tarihleri arasında elektif koroner arter bypass, kapak cerrahisi veya her iki cerrahiyi geçiren hastalar, bu retrospektif kohort çalışmada incelendi. Hastaların preoperative yaş, cinsiyet, body mass index, eski kardiyak cerrahi, unstabil anjina, myojard enfarktüs, kardiyojenik şok öyküsü olması, preoperatif ilaç kullanımı, ek hastalık öyküsü, sol ventrikül ejeksiyon fraksiyonu, intraoperatif geçirdiği cerrahi tipi, cerrahi süresi, kros-klemp süresi, postoperatif hastane ve yoğun bakım kalış süresi, revizyon cerrahisi, hemodiyaliz gereksinimi, mortalite verileri retrospektif olarak kaydedildi.
Bulgular: İleri yaş, cerrahi süresinin ve aort kros klemp süresinin uzun olması, açık kalp cerrahisi geçiren hastalarda renal hasar gelişmesi açısından risk faktörleri olarak bulunmuştur (P=0,002, P=0,03, P=0,02). Geçirilmiş kardiyak cerrahi, cinsiyet, sol ventriküler ejeksiyon fraksiyonu, preoperatif ilaç kullanımı, cerrahi tipi ile ilgili gruplar arası farklılığa rastlanmamıştır (P=0,69, P=0,10, P=0,19, P=0,66, P=0,86). Akut böbrek yetmezliği gelişen hastaların hastanede ve yoğun bakımda kalış süresi daha uzun bulunmuştur (P=0,001, P=0,001). Cerrahi sonrası hemodiyaliz ihtiyacı %1,3, mortalite %2 oranında gözlenmiştir.
Sonuç: Sonuç olarak preoperatif dönemde hastaların ayrıntılı incelenmesi ve mümkün olan optimal sağaltımın yapılmasının, operasyon planının iyi yapılarak renal hasar gelişebilecek hastaların önceden tahmin edilerek yaklaşımın buna göre değiştirilmesinin postoperatif mortalite ve morbiditeyi azaltma konusunda önemli bir yer tutacağı kanısındayız.

Anahtar Kelimeler

• Koroner arter bypass grefleme,Akut böbrek yetmezliği,Risk faktörleri

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