scholarly journals Subclinical Hypothyroidism Increases the Requirement of Renal Replacement Therapy After Cardiac Surgery

2020 ◽  
Vol 23 (4) ◽  
pp. E482-E487 ◽  
Author(s):  
Naim Boran Tumer ◽  
Atike Tekeli Kunt ◽  
Hatice Keles ◽  
Kanat Ozisik ◽  
Serdar Gunaydin
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Subclinical Hypothyroidism ◽  
Kidney Injury ◽  
Group I ◽  
Group Ii ◽  
Postoperative Aki

Background: Subclinical or biochemically diagnosed hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels. Thyroid hormones play a major role in the normal function of the heart and vascular physiology. Atherosclerosis, increased systemic vascular resistance, and decreased arterial compliance are common pathophysiological changes that may occur in hypothyroidism. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, diabetes mellitus (DM), preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of SCH on AKI and the requirement of renal replacement therapy (RRT) after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 336 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL) from January 2017 to January 2019. The patients were divided into two groups either having the diagnosis of SCH (Group I, N = 47) or not (Group II, N = 289). SCH was diagnosed based on preoperative serum TSH and FT4 levels. Kidney injury was interpreted, according to RIFLE classification. The effect of SCH on AKI and the need for RRT after CABG was determined using logistic regression analysis and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. Results: Subclinical hypothyroidism was diagnosed in 14% of all patients. Postoperative AKI occurred in 15 patients (31.9%) in Group I, whereas there were 42 patients (14.5%) in Group II. On logistic regression analysis, the presence of SCH was shown to be associated with an increased incidence of postoperative AKI (OR, 0.363; 95% CI, 0.181-0.727; P = .004). RRT was used in 2.97% of patients (seven patients in Group I and three patients in Group II, P < .001). The 30-day mortality was 2.1%. Conclusion: The presence of SCH seems to be associated with an increased incidence of AKI and increased requirement for RRT after cardiac surgery.

Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

2016 ◽  
Vol 19 (3) ◽  
pp. 123 ◽  
Author(s):  
Orhan Findik ◽  
Ufuk Aydin ◽  
Ozgur Baris ◽  
Hakan Parlar ◽  
Gokcen Atilboz Alagoz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Albumin ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Preoperative Serum ◽  
Group I ◽  
Group Ii

<strong>Background:</strong> Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).<br /><strong>Methods:</strong> We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels &lt;3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.<br /><strong>Results:</strong> There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; <br />P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. <br /><strong>Conclusion:</strong> Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

The Influence of Metabolic Syndrome on Acute Kidney Injury Occurrence after Coronary Artery Bypass Grafting

2016 ◽  
Vol 19 (3) ◽  
pp. 099 ◽  
Author(s):  
Atike Tekeli Kunt ◽  
Hakan Parlar ◽  
Orhan Findik ◽  
Cagri Duzyol ◽  
Ozgur Baris ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Bypass Grafting ◽  
Group I ◽  
Postoperative Aki

<p class="p1"><span class="s1"><strong>Background:</strong> Metabolic syndrome (MetS) is defined as a cluster of systemic abnormalities: hyperglycemia, dyslipidemia, abdominal obesity, and hypertension. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, DM, preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis of the aorta are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of MetS on AKI occurring after coronary artery bypass grafting (CABG).</span></p><p class="p1"><span class="s1"><strong>Methods:</strong> We retrospectively reviewed the prospectively collected data of 500 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value &lt;1.4 mg/dL) from January 2011 to January 2015. The patients were divided into two groups either having the diagnosis of MetS (Group I) or not (Group II). MetS was diagnosed based on International Diabetes Federation definition. Kidney injury was interpreted according to RIFLE classification. The effect of MetS on AKI after CABG was determined using logistic regression analysis and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A <em>P</em> value &lt;.05 was considered <br /> statistically significant.</span></p><p class="p1"><span class="s1"><strong>Results:</strong> Metabolic syndrome was diagnosed in 16.4% of all patients. Postoperative AKI occurred in 26 patients (31.7%) in Group I whereas there were 53 patients (12.7%) in Group II. On logistic regression analysis, the presence of MetS was shown to be associated with increased incidence of postoperative AKI (OR, 3.197; 95% CI, 1.850-5.526; <br /> <em>P</em> = .000).</span></p><p class="p1"><span class="s1"><strong>Conclusion:</strong> The presence of MetS seems to be associated with increased incidence of AKI after cardiac surgery. MetS is a modifiable issue; if its components are well controlled its dreadful effects after cardiac surgery might be controlled as well.</span></p>

scholarly journals Study on Related Factors of Acute Kidney Injury in Patients under Intensive Care

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Zhongbiao Liao
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Urine Volume ◽  
Kidney Injury ◽  
Related Factors

Objectives: To study the related factors of acute kidney injury (AKI) in intensive care unit (ICU) patients. Methods: The clinical data of 879 patients in the intensive care unit were retrospectively analyzed. AKI patients were selected according to the AKI clinical diagnostic criteria, the causal analysis was performed, the indicators of AKI patients were tested, and the urine volume and the time of admission to the ICU were recorded. Finally, logistic regression analysis was used to analyze the risk factors that affect the prognosis. Results: Among the 879 patients in the intensive care unit, 96 patients (10.9%) met the KDIGO-AKI diagnostic criteria, of which 29 (30.31%) died and 49 (51.04%) required renal replacement therapy. As the age and stage of AKI patients increase, the mortality rate also increases. The pathology constituted 46 septic patients (47.92%) and 50 non-septic patients (52.08%). Patients with septic AKI have longer ICU and hospital stay than patients with non-septic AKI (t=2.291, 0.023; t=2.082, 0.041), and the rate of renal replacement therapy is higher(?2=4.091?P=0.042). Logistic regression analysis shows that old age, low urine volume, shock, acidosis, stage 3 of AKI, intake of blood pressure drugs, infections, and the need for renal replacement therapy are relevant factors that affect AKI. Conclusions: In the intensive care unit, the incidence and mortality of AKI are very high; the treatment of AKI is related to many factors; early detection and treatment is very crucial to reduce the mortality of AKI.

scholarly journals Does Aspartate Aminotransferase to Alanine Aminotransferase Ratio Predict Acute Kidney Injury After Cardiac Surgery?

2021 ◽  
Vol 24 (3) ◽  
pp. E506-E511
Author(s):  
Yildirim Gultekin ◽  
Ali Bolat ◽  
Keles Hatice ◽  
Atike Tekeli Kunt
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Logistic Regression Analysis ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
Kidney Injury ◽  
Diagnosis And Prognosis ◽  
Postoperative Aki

Background: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) frequently is used in the diagnosis and prognosis of liver diseases, however it is also used in the diagnosis and prognosis of many other diseases, such as myocardial infarction, acute ischemic stroke, and peripheral artery disease. Acute kidney injury (AKI) is one of the most important complications after cardiac surgery and is one of the main causes of morbidity and mortality. The purpose of the study was to analyze the relationship between AST to ALT and AKI after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 253 adult patients, who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL). Preoperative (T0) and postoperative day 1 and day 3 (T1 and T2) serum AST and ALT levels were analyzed, and AST/ALT was calculated. A preoperative AST/ALT of 1.22 was found to be the best cutoff point for predicting postoperative AKI. Kidney injury was interpreted, according to RIFLE classification. The effect of AST to ALT ratio on AKI after CABG was determined using logistic regression analysis, and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. Results: Postoperative AKI occurred in 40 patients (15.8%). On logistic regression analysis, higher AST/ALT both preoperatively and postoperatively were associated with an increased incidence of postoperative AKI (T0: OR, 3.983; 95% CI, 1.940-8.180, P < .001, T1: OR, 2.760; 95% CI, 1.381-5.515, P = .004, T2: OR, 2.515; 95% CI, 1.195-5.294, P = .015). Conclusion: Preoperative and postoperative elevated AST to ALT ratio seems to be associated with an increased incidence of AKI after elective isolated CABG surgery.

scholarly journals Postoperative acute kidney injury requiring continuous renal replacement therapy and outcomes after coronary artery bypass grafting: a nationwide cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tak Kyu Oh ◽  
In-Ae Song
Keyword(s):  
Cohort Study ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Population Based ◽  
Bypass Grafting ◽  
All Cause Mortality ◽  
Postoperative Aki

Abstract Background Previous studies reported that patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) after cardiac surgery were at a higher risk of postoperative mortality. However, the impact of AKI and CRRT on long-term mortality has not yet been identified. Therefore, we investigated whether postoperative AKI requiring CRRT was associated with one-year all-cause mortality after coronary artery bypass grafting (CABG). Methods For this population-based cohort study, we analyzed data from the National Health Insurance Service database in South Korea. The cohort included all adult patients diagnosed with ischemic heart disease who underwent isolated CABG between January 2012 and December 2017. Results A total of 15,115 patients were included in the analysis, and 214 patients (1.4%) required CRRT for AKI after CABG during hospitalization. They received CRRT at 3.1 ± 8.5 days after CABG, for 3.1 ± 7.8 days. On multivariable Cox regression, the risk of 1-year all-cause mortality in patients who underwent CRRT was 7.69-fold higher. Additionally, on multivariable Cox regression, the 30-day and 90-day mortality after CABG in patients who underwent CRRT were 18.20-fold and 20.21-fold higher than the normal value, respectively. Newly diagnosed chronic kidney disease (CKD) requiring renal replacement therapy (RRT) 1 year after CABG in patients who underwent CRRT was 2.50-fold higher. In the generalized log-linear Poisson model, the length of hospital stay (LOS) in patients who underwent CRRT was 5% longer. Conclusions This population-based cohort study showed that postoperative AKI requiring CRRT was associated with a higher 1-year all-cause mortality after CABG. Furthermore, it was associated with a higher rate of 30-day and 90-day mortality, longer LOS, and higher rate of CKD requiring RRT 1 year after CABG. Our results suggest that CRRT-associated AKI after CABG may be associated with an increased risk of mortality; hence, there should be interventions in these patients after hospital discharge.

scholarly journals Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study

2009 ◽  
Vol 10 (1) ◽  
Author(s):  
Jose Ramon Perez-Valdivieso ◽  
◽  
Pablo Monedero ◽  
Marc Vives ◽  
Nuria Garcia-Fernandez ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cohort Study ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Retrospective Case

scholarly journals Mortality prediction in patients with acute kidney injury requiring renal replacement therapy after cardiac surgery

Medicina ◽  
2017 ◽  
Vol 53 (4) ◽  
pp. 217-223 ◽  
Author(s):  
Inga Skarupskienė ◽  
Dalia Adukauskienė ◽  
Jurgita Kuzminskienė ◽  
Laima Rimkutė ◽  
Vilma Balčiuvienė ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Mortality Prediction

scholarly journals Insights into the Therapeutic of Glucocorticoid for Refractory Mycoplasma Pneumoniae Pneumonia in Children

2020 ◽  
Author(s):  
Zhenli Zhu ◽  
Tongqiang Zhang ◽  
Wei Guo ◽  
Yaoyao Ling ◽  
Jiao Tian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Mycoplasma Pneumoniae ◽  
Logistic Regression Analysis ◽  
Roc Curve ◽  
Severe Illness ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Mycoplasma Pneumoniae Pneumonia

Abstract Objective To observe the efficacy and safety of different doses of glucocorticoid for refractory mycoplasma pneumoniae pneumonia in children, analyze the clinical characteristics in different groups of patients, and explore the factors related to affect illness severity for children with refractory mycoplasma pneumoniae pneumonia and guide the dosage of glucocorticoids.Methods Retrospective analysis was performed on 279 children with refractory mycoplasma pneumoniae pneumonia hospitalized in our hospital between September 2018 and October 2019. 23 children were excluded, the remaining 256 children were divided into three subgroups: Group I was not given methylprednisolone (n=75), group II (n=115) was given methylprednisolone ≤125mg/d, and group III was given methylprednisolone >125mg/d (n=66). The clinical features, laboratory data, radiological manifestations between three subgroups of children were compared, relevant indicators with meaningful were used for ROC curve and multiple logistic regression analysis, and the optimal values of related factors were analyzed.Results The median age and median weight of the group III were greater than the group II（P <0.05）, the median age and median weight of the group I were greater than the group II（P <0.05）, there was no statistical significance in median age and median weight between group III and group I（P>0.05）. The group II is more serious than that of group I, and group III is more serious than that of group II, higher incidence of hypoxemia, longer fever, longer hospital stays, higher incidence of extrapulmonary complications, and more severe of radiological findings (P <0.05). The more severe presentation of disease, hormones dosage was larger, the use rate of gamma globulin was higher, the use rate of bronchoscopy was higher, and higher incidence of plastic bronchitis (P <0.05). Meanwhile, WBC, CRP, LDH, FER, D-D dimer, APTT, PLT, PCT, IL-6, ALT and the percentage of neutrophils in the three groups showed a gradual upward trend (P <0.05). In ROC curve analysis, WBC, neutrophils percentage, CRP, LDH, Fer, PCT and IL-6 can be used to distinguish RMPP with different severity and to guide the dosage of glucocorticoids. Multivariate logistic regression analysis showed that LDH 424.5IU/L, PCT 0.145ng/ml, IL-6 26.69pg/ml and lung consolidation were significant predictors for the severity of RMPP and glucocorticoids dose.Conclusions LDH 424.5IU/L, PCT 0.145 ng/ml, IL-6 26.69pg/ml and pulmonary consolidation as markers of disease severity in patients with RMPP and the dosage of glucocorticoids, which can aid in early recognition of children with severe illness, use appropriate doses of hormones, and reduce sequelae.

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