Impact of mean perfusion pressure and vasoactive drugs on occurrence and reversal of cardiac surgery-associate acute kidney injury: A cohort study
Section snippets
Background
Cardiac surgery-associated acute kidney injury (CSA-AKI) occurs in up to 30% of adult patients who undergo cardiac surgery and has important implications for use of resources, costs and outcomes [1,2]. It is a syndrome with various etiologies and different trajectories of AKI [3].
The most important pathophysiologic pathways leading to CSA-AKI include inflammation caused by the surgical procedure and exposure to the extracorporeal cardiopulmonary bypass, trombo-embolic events and altered
Study design and setting
This was a retrospective, single center, cohort study in a tertiary hospital. The recommendations of the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement were followed. The checklist is reported in the electronic supplement (electronic supplement 1) [11].
Period of inclusion, data collection, inclusion and exclusion criteria
All adult patients, age 18 years or older, who underwent cardiac surgery from 1 January 2012 until 31 December 2017 were included. To study true CSA-AKI and to minimize the effects of the use of
Patient characteristics
During the inclusion period, 4247 patients were admitted to the cardiac ICU, and after exclusion of 832 patients, a total of 3415 adult patients were eligible for analysis (Fig. 2). Baseline patient characteristics are summarized in Table 1. Almost three quarters of patients were male, the majority required isolated coronary artery bypass graft (CABG). The surgical procedure was urgent in 9.5%, and median EuroSCORE II was 1.65 (IQR; 0.99–3.45).
AKI ≥2 occurred in 1277 patients (37.4%). In
Key findings
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Mean perfusion pressure was associated with occurrence and reversal of CSA-AKI ≥ 2.
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Venous congestion, measured by CVP, was associated with development of CSA-AKI ≥2.
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Reversal of CSA-AKI ≥ 2 was associated with increased blood pressure.
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Vasoactive therapy was not associated with occurrence or reversal of CSA-AKI ≥ 2.
Relationship to previous studies
AKI ≥2 occurred in more than one third of the patients during the early phase after cardiac surgery. This is similar to the incidence of CSA-AKI reported previously [1]. AKI was
Conclusion
CSA-AKI stage≥2 occurred in one third of patients, and fully reversed at ICU discharge in 76% of cases. Development as well as full recovery of CSA-AKI ≥2 was affected by mean perfusion pressure, independent of vaso-inotropic use. CVP had a significant effect on development of AKI, while MAP was associated with full AKI reversal.
Ethics approval and consent to participate
This study was approved by the medical ethical committee of Ghent University Hospital (1st March 2018, B670201835389). Given the retrospective cohort design using anonymized data, the need for informed consent was waived.
Consent for publication
Not applicable.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. All data generated or analyzed during this study are included in this published article [and its supplementary information files].
Authors'contribution
WV designed the trial, analyzed and interpreted patient data, drafted the manuscript, and read and approved the manuscript.
TB advised in statistics, drafted the manuscript, and read and approved the manuscript.
FD collected and delivered patient data, drafted the manuscript, and read and approved the manuscript.
IH helped draft the manuscript, and read and approved the manuscript.
KF helped draft the manuscript, and read and approved the manuscript.
HP helped draft the manuscript, and read and
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.
Declaration of Competing Interest
JDW is supported by a grant from the Research Foundation Flanders (Senior Clinical Investigator Grant FWO), has consulted for MSD and Pfizer. EH is supported by a grant from the Research Foundation Flanders (Senior Clinical Investigator Grant FWO). All other authors declared no competing interests.
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