Araştırma Makalesi
BibTex RIS Kaynak Göster

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

Yıl 2020, , 340 - 345, 01.05.2020
https://doi.org/10.28982/josam.642118

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.

Destekleyen Kurum

yok

Proje Numarası

yok

Kaynakça

  • 1. Fortes JV, Barbosa e Silva MG, Baldez TE, Costa MA, Silva LN, Pinheiro RS, et al. Mortality risk after cardiac surgery: application of Inscor in a University Hospital in Brazil’s Northeast. Braz J Cardiovasc Surg. 2016;31(5):396-9.
  • 2. Chertow GM, Lazarus JM, Christiansen CL, Cook EF, Hammermeister KE, Grover F, et al. Preoperative renal risk stratification. Circulation. 2012;95:878-84.
  • 3. Prowle JR, Kam EP, Ahmad T, Smith NC, Protopapa K, Pearse RM. Preoperative renal dysfunction and mortality after non-cardiac surgery. Br J Surg. 2016;103:1316–25.
  • 4. Corredor C, Thomson R, Al-Subaie N. Long-term consequences of acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2016;30(1):69-75.
  • 5. Bernardi MH, Schmidlin D, Schiferer A, Ristl R, Neugebauer T, et al. Impact of preoperative serum creatinine on short- and long-term mortality after cardiac surgery: a cohort study. Br J Anaesth. 2015;114:53–62.
  • 6. Jiang W, Xu J, Shen B, Wang C, Teng J, Ding X. Validation of four prediction scores for cardiac surgery-associated acute kidney injury in Chinese patients. Braz J Cardiovasc Surg. 2017;32(6):481-6.
  • 7. http://www.nefroloji.org.tr/formul.php#
  • 8. Lopez-Delgado JC, Esteve F, Torrado H, Rodríguez-Castro D, Carrio ML, Farrero E, et al. Influence of acute kidney injury on short- and longterm outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification. Critical Care. 2013;17(6):R293.
  • 9. Hudson C, Hudson J, Swaminathan M, Shaw A, Stafford-Smith M, Patel UD. Emerging Concepts in Acute Kidney Injury Following Cardiac Surgery. Semin Cardiothorac Vasc Anesth. 2008;12(4):320–30.
  • 10. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1-138.
  • 11. Loubon CO, Molina MF, Hinojal YC, Enrique FC. Cardiac surgery-associated acute kidney injury. Ann Card Anaesth. 2016;19(4):687–98.
  • 12. Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15:1597-605.
  • 13. Lau G, Wald R, Sladen R, Mazer CD. Acute Kidney Injury in Cardiac Surgery and Cardiac Intensive Care Seminars in Cardiothoracic and Vascular Anesthesia 2015;19(4):270–87.
  • 14. Jang MS, Nam JS, Jo JY, Kang CH, Ryu SA, Lee EH, et al. The relationship of preoperative estimated glomerular filtration rate and outcomes after cardiovascular surgery in patients with normal serum creatinine: a retrospective cohort study. BMC Anesthesiology. 2019;19:88.
  • 15. Wang F, Dupuis JY, Nathan H, Williams K. An analysis of the association between preoperative renal dysfunction and outcome in cardiac surgery: estimated creatinine clearance or plasma creatinine level as measures of renal function. Chest. 2003;124:1852–62.
  • 16. Welten GM, Schouten O, Chonchol M, Hoeks SE, Feringa HH, Bax JJ, et al. Temporary worsening of renal function after aortic surgery is associated with higher long-term mortality. Am J Kidney Dis. 2007;50:219–28.
  • 17. Mooney JF, Ranasinghe I, Chow CK, Perkovic V, Barzi F, Zoungas S, et al. Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis. Anesthesiology. 2013;118:809–24.
  • 18. Cywinski JB, Mascha EJ, Kurz A, Sessler DI. Estimated glomerular filtration rate better predicts 30-day mortality after non-cardiac surgery than serum creatinine: a retrospective analysis of 92.888 patients. Can J Anaesth. 2015;62:745–52.
  • 19. Cohen JS, Gu A, Wei C, Sobrio SA, Liu J, Abdel MP, et al. Preoperative estimated glomerular filtration rate is a marker for postoperative complications following revision total knee arthroplasty. J Arthroplast. 2018.
  • 20. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J, et al. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104:343-8.
  • 21.Wang Y, Zou Z, Jin J, Teng J, Xu J, Shen B, et al. Urinary TIMP-2 and IGFBP7 for the prediction of acute kidney injury following cardiac surgery. BMC Nephrology 2017;18:177.
  • 22. Wijeysundera DN, Karkouti K, Beattie WS, Rao V, Ivanov J. Improving the identification of patients at risk of postoperative renal failure after cardiac surgery. Anesthesiology. 2006;104:65–72.
  • 23. Redfors B, Bragadottir G, Sellgren J, Sward K, Ricksten SE. Acute renal failure is NOT an “acute renal success” - a clinical study on the renal oxygen supply/demand relationship in acute kidney injury. Crit Care Med. 2010;38:1695-701.
  • 24. Coleman MD, Shaefi S, Sladen RN. Preventing acute kidney injury after cardiac surgery. Curr. Opin. Anaesthesiol. 2011:24:70–6.
  • 25. O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 2016;20:187.
  • 26. Magro MC, Franco ES, Guimarães D, Kajimoto D, Gonçalves MA, Vattimo M F. Evaluation of the renal function in patients in the postoperative period of cardiac surgery: does AKIN classification predict acute kidney dysfunction? Rev Bras Ter Intensiva. 2009;21(1):25-31.
  • 27. Santos FO, Silveira MA, Maia RB, Monteiro MD, Martinalli R. Acute renal failure after coronary artery bypass surgery with extracorporeal circulation: incidence, risk factors, and mortality. Arq Bras Cardiol. 2004;83(2):150-4.
  • 28. Billings FT, Hendricks PA, Schildcrout JS, Shi Y, Petracek MR, Bryne JG, et al. High-dose perioperative atorvastatin and acute kidney injury following cardiac surgery: a randomized clinical trial. JAMA. 2016;315:877–88.
  • 29. Zheng, Z, Jayaram R, Jiang L, Emberson J, Zhao Y, Li Q, et al. Perioperative rosuvastatin in cardiac surgery. N Engl J Med. 2016:374:1744-53.
  • 30. Park JH, Shim JK, Song JW, Soh S, Kwak YL. Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery: a randomized, placebo-controlled trial. Intensive Care Med. 2016;42:1398–407.
  • 31.Argalious M, Xu M, Sun Z, Smedira N, Koch CG. Preoperative statin therapy is not associated with a reduced incidence of postoperative acute kidney injury after cardiac surgery. Anesth. Analg. 2010;11:324–30.
  • 32.Rodrigues AJ, Evora PR, Bassetto S, Alves Junior L, Scorzoni Filho A, Araujo WF, et al. Risk factors for acute renal failure after heart surgery. Rev Bras Cir Cardiovasc. 2009;24(4):441-6.
  • 33. Ramos KA, Dias CB. Acute Kidney Injury after Cardiac Surgery in Patients Without Chronic Kidney Disease. Braz J Cardiovasc Surg. 2018;33(5):454-61.
  • 34. Suen WS, Mok CK, Chiu SW, Cheung KL, Lee WT, Cheung D, et al. Risk factors for development of acute renal failure (ARF) requiring dialysis in patients undergoing cardiac surgery. Angiology. 1998;49(10):789-800.
  • 35. Ninni S, Seunes C, Ortmans S, Mouton S, Modine T, Koussa M, et al. Peri-operative acute kidney injury upon cardiac surgery time-of-day. International Journal of Cardiology. 2018;272:54-9.

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

Yıl 2020, , 340 - 345, 01.05.2020
https://doi.org/10.28982/josam.642118

Öz

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. 

Proje Numarası

yok

Kaynakça

  • 1. Fortes JV, Barbosa e Silva MG, Baldez TE, Costa MA, Silva LN, Pinheiro RS, et al. Mortality risk after cardiac surgery: application of Inscor in a University Hospital in Brazil’s Northeast. Braz J Cardiovasc Surg. 2016;31(5):396-9.
  • 2. Chertow GM, Lazarus JM, Christiansen CL, Cook EF, Hammermeister KE, Grover F, et al. Preoperative renal risk stratification. Circulation. 2012;95:878-84.
  • 3. Prowle JR, Kam EP, Ahmad T, Smith NC, Protopapa K, Pearse RM. Preoperative renal dysfunction and mortality after non-cardiac surgery. Br J Surg. 2016;103:1316–25.
  • 4. Corredor C, Thomson R, Al-Subaie N. Long-term consequences of acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2016;30(1):69-75.
  • 5. Bernardi MH, Schmidlin D, Schiferer A, Ristl R, Neugebauer T, et al. Impact of preoperative serum creatinine on short- and long-term mortality after cardiac surgery: a cohort study. Br J Anaesth. 2015;114:53–62.
  • 6. Jiang W, Xu J, Shen B, Wang C, Teng J, Ding X. Validation of four prediction scores for cardiac surgery-associated acute kidney injury in Chinese patients. Braz J Cardiovasc Surg. 2017;32(6):481-6.
  • 7. http://www.nefroloji.org.tr/formul.php#
  • 8. Lopez-Delgado JC, Esteve F, Torrado H, Rodríguez-Castro D, Carrio ML, Farrero E, et al. Influence of acute kidney injury on short- and longterm outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification. Critical Care. 2013;17(6):R293.
  • 9. Hudson C, Hudson J, Swaminathan M, Shaw A, Stafford-Smith M, Patel UD. Emerging Concepts in Acute Kidney Injury Following Cardiac Surgery. Semin Cardiothorac Vasc Anesth. 2008;12(4):320–30.
  • 10. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1-138.
  • 11. Loubon CO, Molina MF, Hinojal YC, Enrique FC. Cardiac surgery-associated acute kidney injury. Ann Card Anaesth. 2016;19(4):687–98.
  • 12. Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15:1597-605.
  • 13. Lau G, Wald R, Sladen R, Mazer CD. Acute Kidney Injury in Cardiac Surgery and Cardiac Intensive Care Seminars in Cardiothoracic and Vascular Anesthesia 2015;19(4):270–87.
  • 14. Jang MS, Nam JS, Jo JY, Kang CH, Ryu SA, Lee EH, et al. The relationship of preoperative estimated glomerular filtration rate and outcomes after cardiovascular surgery in patients with normal serum creatinine: a retrospective cohort study. BMC Anesthesiology. 2019;19:88.
  • 15. Wang F, Dupuis JY, Nathan H, Williams K. An analysis of the association between preoperative renal dysfunction and outcome in cardiac surgery: estimated creatinine clearance or plasma creatinine level as measures of renal function. Chest. 2003;124:1852–62.
  • 16. Welten GM, Schouten O, Chonchol M, Hoeks SE, Feringa HH, Bax JJ, et al. Temporary worsening of renal function after aortic surgery is associated with higher long-term mortality. Am J Kidney Dis. 2007;50:219–28.
  • 17. Mooney JF, Ranasinghe I, Chow CK, Perkovic V, Barzi F, Zoungas S, et al. Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis. Anesthesiology. 2013;118:809–24.
  • 18. Cywinski JB, Mascha EJ, Kurz A, Sessler DI. Estimated glomerular filtration rate better predicts 30-day mortality after non-cardiac surgery than serum creatinine: a retrospective analysis of 92.888 patients. Can J Anaesth. 2015;62:745–52.
  • 19. Cohen JS, Gu A, Wei C, Sobrio SA, Liu J, Abdel MP, et al. Preoperative estimated glomerular filtration rate is a marker for postoperative complications following revision total knee arthroplasty. J Arthroplast. 2018.
  • 20. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J, et al. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104:343-8.
  • 21.Wang Y, Zou Z, Jin J, Teng J, Xu J, Shen B, et al. Urinary TIMP-2 and IGFBP7 for the prediction of acute kidney injury following cardiac surgery. BMC Nephrology 2017;18:177.
  • 22. Wijeysundera DN, Karkouti K, Beattie WS, Rao V, Ivanov J. Improving the identification of patients at risk of postoperative renal failure after cardiac surgery. Anesthesiology. 2006;104:65–72.
  • 23. Redfors B, Bragadottir G, Sellgren J, Sward K, Ricksten SE. Acute renal failure is NOT an “acute renal success” - a clinical study on the renal oxygen supply/demand relationship in acute kidney injury. Crit Care Med. 2010;38:1695-701.
  • 24. Coleman MD, Shaefi S, Sladen RN. Preventing acute kidney injury after cardiac surgery. Curr. Opin. Anaesthesiol. 2011:24:70–6.
  • 25. O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 2016;20:187.
  • 26. Magro MC, Franco ES, Guimarães D, Kajimoto D, Gonçalves MA, Vattimo M F. Evaluation of the renal function in patients in the postoperative period of cardiac surgery: does AKIN classification predict acute kidney dysfunction? Rev Bras Ter Intensiva. 2009;21(1):25-31.
  • 27. Santos FO, Silveira MA, Maia RB, Monteiro MD, Martinalli R. Acute renal failure after coronary artery bypass surgery with extracorporeal circulation: incidence, risk factors, and mortality. Arq Bras Cardiol. 2004;83(2):150-4.
  • 28. Billings FT, Hendricks PA, Schildcrout JS, Shi Y, Petracek MR, Bryne JG, et al. High-dose perioperative atorvastatin and acute kidney injury following cardiac surgery: a randomized clinical trial. JAMA. 2016;315:877–88.
  • 29. Zheng, Z, Jayaram R, Jiang L, Emberson J, Zhao Y, Li Q, et al. Perioperative rosuvastatin in cardiac surgery. N Engl J Med. 2016:374:1744-53.
  • 30. Park JH, Shim JK, Song JW, Soh S, Kwak YL. Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery: a randomized, placebo-controlled trial. Intensive Care Med. 2016;42:1398–407.
  • 31.Argalious M, Xu M, Sun Z, Smedira N, Koch CG. Preoperative statin therapy is not associated with a reduced incidence of postoperative acute kidney injury after cardiac surgery. Anesth. Analg. 2010;11:324–30.
  • 32.Rodrigues AJ, Evora PR, Bassetto S, Alves Junior L, Scorzoni Filho A, Araujo WF, et al. Risk factors for acute renal failure after heart surgery. Rev Bras Cir Cardiovasc. 2009;24(4):441-6.
  • 33. Ramos KA, Dias CB. Acute Kidney Injury after Cardiac Surgery in Patients Without Chronic Kidney Disease. Braz J Cardiovasc Surg. 2018;33(5):454-61.
  • 34. Suen WS, Mok CK, Chiu SW, Cheung KL, Lee WT, Cheung D, et al. Risk factors for development of acute renal failure (ARF) requiring dialysis in patients undergoing cardiac surgery. Angiology. 1998;49(10):789-800.
  • 35. Ninni S, Seunes C, Ortmans S, Mouton S, Modine T, Koussa M, et al. Peri-operative acute kidney injury upon cardiac surgery time-of-day. International Journal of Cardiology. 2018;272:54-9.
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kalp ve Damar Cerrahisi
Bölüm Araştırma makalesi
Yazarlar

Zerrin Özçelik 0000-0001-5761-2022

Fatma Zekiye Askar Bu kişi benim 0000-0001-7237-574X

Proje Numarası yok
Yayımlanma Tarihi 1 Mayıs 2020
Yayımlandığı Sayı Yıl 2020

Kaynak Göster

APA Özçelik, Z., & Askar, F. Z. (2020). Frequency and factors affecting the development of acute kidney injury following open heart surgery. Journal of Surgery and Medicine, 4(5), 340-345. https://doi.org/10.28982/josam.642118
AMA Özçelik Z, Askar FZ. Frequency and factors affecting the development of acute kidney injury following open heart surgery. J Surg Med. Mayıs 2020;4(5):340-345. doi:10.28982/josam.642118
Chicago Özçelik, Zerrin, ve Fatma Zekiye Askar. “Frequency and Factors Affecting the Development of Acute Kidney Injury Following Open Heart Surgery”. Journal of Surgery and Medicine 4, sy. 5 (Mayıs 2020): 340-45. https://doi.org/10.28982/josam.642118.
EndNote Özçelik Z, Askar FZ (01 Mayıs 2020) Frequency and factors affecting the development of acute kidney injury following open heart surgery. Journal of Surgery and Medicine 4 5 340–345.
IEEE Z. Özçelik ve F. Z. Askar, “Frequency and factors affecting the development of acute kidney injury following open heart surgery”, J Surg Med, c. 4, sy. 5, ss. 340–345, 2020, doi: 10.28982/josam.642118.
ISNAD Özçelik, Zerrin - Askar, Fatma Zekiye. “Frequency and Factors Affecting the Development of Acute Kidney Injury Following Open Heart Surgery”. Journal of Surgery and Medicine 4/5 (Mayıs 2020), 340-345. https://doi.org/10.28982/josam.642118.
JAMA Özçelik Z, Askar FZ. Frequency and factors affecting the development of acute kidney injury following open heart surgery. J Surg Med. 2020;4:340–345.
MLA Özçelik, Zerrin ve Fatma Zekiye Askar. “Frequency and Factors Affecting the Development of Acute Kidney Injury Following Open Heart Surgery”. Journal of Surgery and Medicine, c. 4, sy. 5, 2020, ss. 340-5, doi:10.28982/josam.642118.
Vancouver Özçelik Z, Askar FZ. Frequency and factors affecting the development of acute kidney injury following open heart surgery. J Surg Med. 2020;4(5):340-5.