Is preoperative vitamin D level a risk factor for acute kidney injury developing after cardiopulmonary bypass?

Year 2022, , 247 - 254, 30.12.2022

Ersin Çelik , Ahmet Çora , Kadir Burhan Karadem

https://doi.org/10.56150/tjhsl.1211890

Abstract

Objective: In this study, the relationship between acute kidney injury (AKI) that developed in the early postoperative period in the patients that underwent open heart surgery with cardiopulmonary bypass (CPB) and their preoperative 25-Hydroxy Vitamin D (25-OHD) levels was investigated.
Method: 285 patients who underwent open heart surgery with CPB between February 2018 and December 2020 were retrospectively analyzed. Ninety seven patients (71 men, 26 women) who met the criteria were included in the study. The patients were divided into 3 groups according to their preoperative 25-OHD levels as deficiency (group I, n=28), insufficiency (group II, n=42) and normal (group III, n=27).Demographic and clinical characteristics, AKI, and CPB time were compared between the groups.Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were used to define postoperative AKI.
Results: According to the KDIGO guidelines, the incidence of postoperative AKI decreased to 19% at the end of 48 hours and to 6.2% at discharge whereas it was 21% in the first 24 hours. The decrease in KDIGO AKI stages was found to be statistically significant (p=0.002). The rate of DM was found to be significantly higher in Group I (p=0.001). No statistical difference was found between AKI and 25-OHD levels at 24 hours, 48 hours and discharge. CPB time was found to be significantly higher in Group I (p=0.006). In the univariate logistic regression model created after 25-OHD groups were taken as low (group I+group II) and normal (group III), low 25-OHD levels were found to have a significant effect on the development of DM (p=0.001, OR:8.474, 95%CI 2.336 -30.303).
Conclusion: Although we could not find a statistical relationship between AKI and preoperative 25-OHD levels in the patients that underwent open heart surgery with CPB, we believe that 25-OHD deficiency might have effects on postoperative morbidity and mortality by affecting the renocardiovascular system.

Keywords

25- Hydroxy Vitamin D, acute kidney injury, cardiopulmonary bypass, renin–angiotensin system

Project Number

yok

References

• Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Wornock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care 2007; 11(2):R31
• Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009; 53(6): 961-73
• Kellum JA, Lameire N, and the KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Critical Care 2013; 17(1): p204
• Pickering JW, James MT, Palmer SC. Acute kidney injury and prognosis after cardiopulmonary bypass: A meta-analysis of cohort studies. Am J Kidney Dis 2015; 65(2):283-93
• Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 2015; 1:19-32
• Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clinic Proceeding 2010; 85(8):pp 752-8
• Judd S, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease. Am J Med Sci 2009; 338: 40-4
• Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117(4):503-11
• Turin A, Bax JJ, Doukas D, Joyce C, Lopez JJ, Mathew V, et all. Interactions among vitamin D, atrial fibrillation, and the renin-angiotensin-aldosterone system. Am J Cardiol 2018; 122(5):780-4
• Landoni G, Zangrillo A, Franco A, Aletti G, Roberti A, Calabrò MG, Slaviero G,Bignami E, Marino G. Long-term outcome of patients who require renalreplacement therapy after cardiac surgery. Eur J Anaesthesiol. 2006;23(1):17–22
• Wittlinger T, Maus M, Kutschkal I, Baraki H, Friedrich MG. Risk assesment of acute kidney injury following cardiopulmonary bypass. Journal of Cardiothoracic Surgery 2021;16:p1
• Machado MN, Nakazone MA, Maia LN. Prognostic value of acute kidneyinjury after cardiac surgery according to kidney disease: improving globaloutcomes definition and staging (KDIGO) criteria. PLoS One. 2014;9:e98028
• Vercaemst L: Hemolysis in cardiac surgery patients undergoing cardiopulmonary bypass: a review in search of a treatment algorithm. J Extra Corpor Technol 2008;40:257–67.
• Boehne M, Sasse M, Karch A, Dziuba F, Horke A, Kaussen T, et al. Systemic inflammatory response syndrome after pediatric congenital heart surgery: incidence, risk factors, and clinical outcome. J Card Surg. 2017;32:116–25
• Liu D, Liu B, Liang Z, Yang Z, Ma F, Yang Y, et al. Acute kidney injury following cardiopulmonary bypass: A challenging Picture. Oxidative Medicine and Cellular Longevity 2021 doi.org/10.1155/2021/8873581
• Schmieder RE, Hilgers KF, Schlaich MP, Schmidt BM. Renin-angiotensin system and cardiovascular risk. Lancet 2007;369:1208-19
• Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25- DihydroxyvitaminD(3) is a negative endocrine regulator of the renin–angiotensin system, J. Clin. Invest. 2002;110:229–38
• Shen Q, Bi X, Ling L, Ding W. 1,25- Dihydroxyvitamin D3 attenuates angiotensin II- induced renal injury by inhibiting mitochondrial dysfunction and autophagy. Cell PhysiolBiochem2018;51:1751-62
• Canning MO, Grotenhuis K, de Wit H, Ruwhof C, Drexhage HA. 1-alpha,25-Dihydroxyvitamin D3 (1,25(OH)(2)d(3)) hampers the maturation of fully active immature dendritic cell from monocytes. Eur J Endocrinol 2001;145:351-7
• Mizobuchi M, Morrissey J, Finch JL, Martin DR, Liapis H, Akizawa T, et al. Combination therapy with an angiotensin-converting enzyme inhibitor and a vitamin D analog suppresses the progression of renal insufficiency in uremic rats. J Am Soc Nephrol 2007;18:1796-806
• Natanov R, Gueler F, Falk CS, Kühn C, Maus U, Boyle EC, et al. Blood cytokine expression correlates with early multi-organ damage in a mause model of moderate hypothermia with circulatory arrest using cardiopulmonary bypass. PLoS ONE 2018;13(10):e0205437
• Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J CardiothoracVascAnesth 2008; 22: 814–22
• Wen Y, Liu Y, Tang T, Lv L, Liu H, Ma K, Liu B: NLRP3 inflammasome activation is involved in Ang II-induced kidney damage via mitochondrial dysfunction. Oncotarget 2016;7:54290-302 Judd S, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease.