Impact of cardiac surgery associated acute kidney injury on 1-year major adverse kidney events

BackgroundThe incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events...

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Main Authors: Alícia Molina Andújar, Victor Joaquin Escudero, Gaston J. Piñeiro, Alvaro Lucas, Irene Rovira, Purificación Matute, Cristina Ibañez, Miquel Blasco, Luis F. Quintana, Elena Sandoval, Marina Chorda Sánchez, Eduard Quintana, Esteban Poch
Format: Article
Language:English
Published: Frontiers Media S.A. 2023-04-01
Series:Frontiers in Nephrology
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Online Access:https://www.frontiersin.org/articles/10.3389/fneph.2023.1059668/full
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Summary:BackgroundThe incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events (MAKE) [25% or greater decline in estimated glomerular filtration rate (eGFR), new hemodialysis, and death] after cardiac surgery in a Spanish cohort and to evaluate the utility of the score developed by Legouis D et al. (CSA-CKD score) in predicting the occurrence of MAKE.MethodsThis was a single-center retrospective study of patients who required cardiac surgery with cardiopulmonary bypass (CPB) during 2015, with a 1-year follow-up after the intervention. The inclusion criteria were patients over 18 years old who had undergone cardiac surgery [i.e., valve substitution (VS), coronary artery bypass graft (CABG), or a combination of both procedures].ResultsThe number of patients with CKD (eGFR < 60 mL/min) increased from 74 (18.3%) to 97 (24%) within 1 year after surgery. The median eGFR declined from 85 to 82 mL/min in the non-CSA-AKI patient group and from 73 to 65 mL/min in those with CSA-AKI (p = 0.024). Fifty-eight patients (1.4%) presented with MAKE at the 1-year follow-up. Multivariate logistic regression analysis showed that the only variable associated with MAKE was CSA-AKI [odds ratio (OR) 2.386 (1.31–4.35), p = 0.004]. The median CSA-CKD score was higher in the MAKE cohort [3 (2–4) vs. 2 (1–3), p < 0.001], but discrimination was poor, with a receiver operating characteristic curve (AUC) value of 0.682 (0.611–0.754).ConclusionAny-stage CSA-AKI is associated with a risk of MAKE after 1 year. Further research into new measures that identify at-risk patients is needed so that appropriate patient follow-up can be carried out.
ISSN:2813-0626