Reversible preoperative renal dysfunction does not add to the risk of postoperative acute kidney injury after cardiac valve surgery
Authors Xu JR, Zhuang YM, Liu L, Shen B, Wang YM, Luo Z, Teng J, Wang CS, Ding XQ
Received 7 August 2017
Accepted for publication 5 October 2017
Published 10 November 2017 Volume 2017:13 Pages 1499—1505
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Hoa Le
Peer reviewer comments 2
Editor who approved publication: Professor Deyun Wang
Jia-Rui Xu,1–3 Ya-Min Zhuang,4 Lan Liu,4 Bo Shen,1–3 Yi-Mei Wang,1–3 Zhe Luo,4 Jie Teng,1–3,5 Chun-Sheng Wang,4 Xiao-Qiang Ding1–3
1Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 2Shanghai Institute for Kidney and Dialysis, Shanghai, 3Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 4Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 5Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
Objective: To evaluate the impact of the renal dysfunction (RD) type and change of postoperative cardiac function on the risk of developing acute kidney injury (AKI) in patients who underwent cardiac valve surgery.
Method: Reversible renal dysfunction (RRD) was defined as preoperative RD in patients who had not been initially diagnosed with chronic kidney disease (CKD). Cardiac function improvement (CFI) was defined as postoperative left ventricular ejection function – preoperative left ventricular ejection function (ΔEF) >0%, and cardiac function not improved (CFNI) as ΔEF ≤0%.
Results: Of the 4,805 (94%) cardiac valve surgery patients, 301 (6%) were RD cases. The AKI incidence in the RRD group (n=252) was significantly lower than in the CKD group (n=49) (36.5% vs 63.3%, P=0.018). The AKI and renal replacement therapy incidences in the CFI group (n=174) were significantly lower than in the CFNI group (n=127) (33.9% vs 50.4%, P=0.004; 6.3% vs 13.4%, P=0.037). After adjustment for age, gender, and other confounding factors, CKD and CKD + CFNI were identified as independent risk factors for AKI in all patients after cardiac valve surgery. Multivariate logistic regression analysis showed that the risk factors for postoperative AKI in preoperative RD patients were age, gender (male), hypertension, diabetes, chronic heart failure, cardiopulmonary bypass time (every 1 min added), and intraoperative hypotension, while CFI after surgery could reduce the risk.
Conclusion: For cardiac valve surgery patients, preoperative CKD was an independent risk factor for postoperative AKI, but RRD did not add to the risk. Improved postoperative cardiac function can significantly reduce the risk of postoperative AKI.
Keywords: acute kidney injury, cardiac valve surgery, renal dysfunction, reversible renal dysfunction
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