Risk Factor of Acute Renal Failure after Open Heart Surgery
Keywords:
Acute renal failure, Cardiac surgery, Risk factorsAbstract
Background: Acute renal failure (ARF) is one of the most serious complications of cardiac surgery. Its incidence varies between 1 and 30%. ARF requiring renal replacement therapy (ARF-RT) develops in 1% to 5% of patients and is associated with a very high mortality. Objective: This study evaluated the risk factors of ARF in a surgical population with or without preoperative renal dysfunction. Method: This was a cross-sectional study reviewing the medical records of 1,000 patients undergoing cardiac surgery. Data were collected from October 1, 2020 to September 30, 2021, using the data collection on the incidence of acute renal failure in patients undergoing cardiac surgery. The relationship between factors was analyzed using the chi-square test and stepwise binary logistic regression analysis. Result: From the sample of 1,000 cardiac surgical patients, it was found that the risk factors associated with acute renal failure after cardiac surgery, by the analysis of multivariate forward stepwise binary logistic regression, were age group (adjusted OR 7.40, 95%CI: 2.99, 18.29, p <. 001), male gender (adjusted OR 1.656, 95%CI: 1.18, 2.332, p = .004), left ventricular dysfunction (adjusted OR 1.446, 95%CI: 1.1,1.89, p =. 007), history of chronic kidney disease (adjusted OR 1.446, 95%CI: 1.1,1.89, p = .007), pre-operative IABP (adjusted OR 3.768, 95%CI: 2.43, 5.85, p < .001), higher pre-operative creatinine level (mg%) (adjusted OR 2.173, 95%CI: 1.39, 3.4, p = .001) with accuracy rate of 80.2 and area of ROC of 0.701±0.021 (95%CI: 0.661, 0.742, p-value < .001). Conclusion: The male patients with left ventricular dysfunction and underling chronic kidney disease who underwent open heart surgery should have prophylactic guideline in order to prevent acute renal failure after cardiac surgery in patients who had preoperative IABP had significant risk for developing acute renal failure that required treatment guidelines for reducing morbidity and mortality.
References
Chertow GM, Lazarus JM, Christiansen CL, Cook EF, Hammermeister KE, Grover F, et al. Preoperative renal risk stratification. Circulation 1997;95(4):878-84.
Fortescue EB, Bates DW, Chertow GM. Predicting acute renal failure after coronary bypass surgery: cross-validation of two risk-stratification algorithms. Kidney Int 2000;57(6):2594-602.
Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996;50(3):811-8.
Andersson LG, Ekroth R, Bratteby LE, Hallhagen S, Wesslen O. Acute renal failure after coronary surgery--a study of incidence and risk factors in 2009 consecutive patients. Thorac Cardiovasc Surg 1993;41(4):237-41.
Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998;104(4):343-8.
McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 1997;103(5):368-75.
Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, et al. Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999;14(5):1158-62.
Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol 2017;13(11):697-711.
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.
Hobson CE, Yavas S, Segal MS, Schold JD, Tribble CG, Layon AJ, et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation 2009;119(18):2444-53.
Lenihan CR, Montez-Rath ME, Mora Mangano CT, Chertow GM, Winkelmayer WC. Trends in acute kidney injury, associated use of dialysis, and mortality after cardiac surgery, 1999 to 2008. Ann Thorac Surg 2013;95(1):20-8.
Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery. Eur J Cardiothorac Surg 2008;34(5):953-9.
Ostermann ME, Taube D, Morgan CJ, Evans TW. Acute renal failure following cardiopulmonary bypass: a changing picture. Intensive Care Med 2000;26(5):565-71.
Zanardo G, Michielon P, Paccagnella A, Rosi P, Caló M, Salandin V, et al. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 1994;107(6):1489-95.
Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The multicenter study of perioperative ischemia research group. Ann Intern Med 1998;128(3):194-203.
Urzua J, Troncoso S, Bugedo G, Canessa R, Munoz H, Lema G, et al. Renal function and cardiopulmonary bypass: effect of perfusion pressure. J Cardiothorac Vasc Anesth 1992;6(3):299-303.
Gamoso MG, Phillips-Bute B, Landolfo KP, Newman MF, Stafford-Smith M. Off-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction. Anesth Analg 2000;91(5):1080-4.
Gormley SM, McBride WT, Armstrong MA, Young IS, McClean E, MacGowan SW, et al. Plasma and urinary cytokine homeostasis and renal dysfunction during cardiac surgery. Anesthesiology 2000;93(5):1210-6; discussion 5A.
Boldt J, Brenner T, Lehmann A, Suttner SW, Kumle B, Isgro F. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg 2003;75(3):906-12.
Cartier R. Current trends and technique in OPCAB surgery. J Card Surg 2003;18(1):32-46.
Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999;68(2):493-8.
Rahmanian PB, Kwiecien G, Langebartels G, Madershahian N, Wittwer T, Wahlers T. Logistic risk model predicting postoperative renal failure requiring dialysis in cardiac surgery patients. Eur J Cardiothorac Surg 2011;40(3):701-7.
Wang Y, Huang X, Xia S, Huang Q, Wang J, Ding M, et al. Gender differences and risk factors for acute kidney injury following cardiac surgery: a single center retrospective cohort study. Heliyon 2023;9(12):e22177.
Wang J, Yu W, Gao M, Gu C, Yu Y. Preoperative prophylactic intraaortic balloon pump reduces the incidence of postoperative acute kidney injury and short-term death of high-risk patients undergoing coronary artery bypass grafting: a meta-analysis of 17 studies. Ann Thorac Surg 2016;101(5):2007-19.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Department of Medical Services, Ministry of Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของกรมการแพทย์ กระทรวงสาธารณสุข
ข้อความและข้อคิดเห็นต่างๆ เป็นของผู้เขียนบทความ ไม่ใช่ความเห็นของกองบรรณาธิการหรือของวารสารกรมการแพทย์
