scholarly journals Acute kidney injury and cardiac surgery: impact of fluid balance on AKI classification and prognosis

Critical Care ◽  
2014 ◽  
Vol 18 (Suppl 1) ◽  
pp. P367
Author(s):  
EM Moore ◽  
A Tobin ◽  
D Reid ◽  
J Santamaria ◽  
R Bellomo
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Fluid Balance ◽  
Kidney Injury

scholarly journals Clinical and Operative Determinants of Acute Kidney Injury after Cardiac Surgery

2020 ◽  
Vol 10 (5) ◽  
pp. 340-352
Author(s):  
Faeq Husain-Syed ◽  
Maria Giovanna Quattrone ◽  
Fiorenza Ferrari ◽  
Pércia Bezerra ◽  
Salvador Lopez-Giacoman ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Cardiac Surgery ◽  
Minimally Invasive Surgery ◽  
Cardiopulmonary Bypass ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Fluid Balance ◽  
Kidney Injury ◽  
Baseline Serum

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with increased morbidity and mortality. Objectives: We aimed to identify potentially modifiable risk factors for CSA-AKI. Methods: This was asingle-center retrospective cohort study of 495 adult patients undergoing cardiac surgery. AKI was diagnosed and staged using full KDIGO criteria incorporating baseline serum creatinine (SC) levels and correction of postoperative SC levels for fluid balance. We examined the association of routinely available clinical and laboratory data with AKI using multivariate logistic regression modeling. Results: A total of 103 (20.8%) patients developed AKI: 16 (15.5%) patients were diagnosed with AKI upon hospital admission, and 87 (84.5%) patients were diagnosed with CSA-AKI. Correction of SC levels for fluid balance increased the number of AKI cases to 104 (21.0%), with 6 patients categorized to different AKI stages. Univariate logistic regression analysis identified five preoperative (age, sex, diabetes mellitus, preoperative systolic pulmonary arterial pressure [PSPAP], acute decompensated heart failure) and five intraoperative predictors of AKI (age, sex, red blood cell [RBC] volume transfused, use of minimally invasive surgery, duration of cardiopulmonary bypass). When all preoperative and intraoperative variables were incorporated into one model, six predictors remained significant (age, sex, use of minimally invasive surgery, RBC volume transfused, PSPAP, duration of cardiopulmonary bypass). Model discrimination performance showed an area under the curve of 0.69 for the model including only preoperative variables, 0.76 for the model including only intraoperative variables, and 0.77 for the model including all preoperative and intraoperative variables. Conclusions: Use of minimally invasive surgery and therapies mitigating PSPAP and intraoperative blood loss may offer protection against CSA-AKI.

Positive association between intra-operative fluid balance and post-operative acute kidney injury in non-cardiac surgery: the NARA-AKI cohort study

2019 ◽  
Vol 33 (3) ◽  
pp. 561-568 ◽  
Author(s):  
Masatoshi Nishimoto ◽  
Miho Murashima ◽  
Maiko Kokubu ◽  
Masaru Matsui ◽  
Masahiro Eriguchi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cohort Study ◽  
Fluid Balance ◽  
Kidney Injury ◽  
Positive Association

Assessing association between fluid balance and acute kidney injury after cardiac surgery

2018 ◽  
Vol 45 ◽  
pp. 249 ◽  
Author(s):  
Yi Liu ◽  
Fu-Shan Xue ◽  
Ya-Yang Liu ◽  
Gui-Zhen Yang
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Fluid Balance ◽  
Kidney Injury

Perioperative Hemodynamic Instability and Fluid Overload are Associated with Increasing Acute Kidney Injury Severity and Worse Outcome after Cardiac Surgery

2017 ◽  
Vol 43 (4) ◽  
pp. 298-308 ◽  
Author(s):  
Anja Haase-Fielitz ◽  
Michael Haase ◽  
Rinaldo Bellomo ◽  
Paolo Calzavacca ◽  
Anke Spura ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Fluid Balance ◽  
Injury Severity ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Chronic Obstructive ◽  
Hemodynamic Management ◽  
Physiological Variables

Purpose: The study aimed to investigate patients' characteristics, fluid and hemodynamic management, and outcomes according to the severity of cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: In a single-center, prospective cohort study, we enrolled 282 adult cardiac surgical patients. In a secondary analysis, we assessed preoperative patients' characteristics, physiological variables, and medication for intra- and postoperative fluid and hemodynamic management and outcomes according to CSA-AKI stages by the Renal risk, Injury, Failure, Loss, End-stage renal disease (RIFLE) classification. Variables of fluid and hemodynamic management were further assessed with regard to the need for postoperative renal replacement therapy (RRT) and in-hospital mortality by the area under the curve for the receiver operating characteristic (AUC-ROC) and multivariate regression analysis. Results: Patients with worsening RIFLE stage, were significantly older, had lower estimated glomerular filtration rate and higher body mass index, more peripheral vascular and chronic obstructive pulmonary disease, atrial fibrillation, and prolonged duration of cardiopulmonary bypass (all p < 0.01). Patients with more severe AKI stage stayed longer in the intensive care and hospital, had higher in-hospital mortality, and requirement for RRT (all p < 0.001). Also, with worsening RIFLE stage, patients had lower intraoperative mean arterial pressure (MAP); p = 0.047, despite higher doses of norepinephrine (p < 0.001). The intraoperative MAP showed the best discriminatory ability (AUC-ROC: >0.8) for and was independently associated with RRT and in-hospital mortality. Moreover, with increasing AKI severity, patients received significantly more fluid infusion, and required higher dose of furosemide; nonetheless, they had increased postoperative fluid balance. Conclusions: In this cohort, reduced MAP and increased fluid balance were independently associated with increased mortality and need for RRT after cardiac surgery.

The Impact of Fluid Balance on the Detection, Classification and Outcome of Acute Kidney Injury After Cardiac Surgery

2015 ◽  
Vol 29 (5) ◽  
pp. 1229-1235 ◽  
Author(s):  
Elizabeth Moore ◽  
Antony Tobin ◽  
David Reid ◽  
John Santamaria ◽  
Eldho Paul ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Fluid Balance ◽  
Kidney Injury ◽  
The Impact

Relationship among Mortality of Patients with Acute Kidney Injury after Cardiac Surgery, Fluid Balance and Ultrafiltration of Renal Replacement Therapy: An Observational Study

2017 ◽  
Vol 44 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Buyun Wu ◽  
Jian Sun ◽  
Si Liu ◽  
Xiangbao Yu ◽  
Yamei Zhu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Cox Regression ◽  
Kidney Injury ◽  
Ultrafiltration Rate ◽  
Survival Group ◽  
Cox Regression Analysis

Background/Aims: The study aimed to investigate the relationship among mortality of patients with cardiac surgery-associated acute kidney injury (CSA-AKI), fluid balance, and ultrafiltration of renal replacement therapy (RRT). Methods: From January 2009 to October 2015, hospitalized patients with CSA-AKI receiving continuous or prolonged intermittent RRT were screened. The effects of fluid balance and ultrafiltration of RRT on clinical outcome were analyzed. Results: The 30-day mortality of all the 63 patients in the study was 58.6%. Compared with the death group, the survival group had a significantly lower fluid balance, larger ultrafiltration volume, and similar ultrafiltration rate during the first 3 days of RRT. Multivariate Cox regression analysis revealed that positive fluid balance during the first day of RRT, cardiac function of grade IV, and higher Sequential Organ Failure Assessment score were independent risk factors of 30-day mortality. Conclusion: Fluid balance was more relevant to short-term prognosis of CSA-AKI-RRT patients than ultrafiltration volume or ultrafiltration rate.

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