Analysis Of Clinical And Risk Factors Of Acute Renal Injury After Surgery

BackgroundAcute kidney injury (AKI) is a prevalent and prognostically significant complication in surgical patients. Depending on the AKI definitions adopted and the population studied, AKI occurs in up to 16%-48% of surgical patients. AKI after any type of surgery is independently associated with substantially worse outcomes, including higher short-term mortality, prolonged length of hospital stay, worsenedlong-term survival, and increased risk of end stage renal disease (ESRD).More than 80% of routine cardiac surgical procedures are performed using cardiopulmonary bypass (CPB). The pathophysiologic features of CPB-AKI are complex and multifactorial. Reduced renal perfusion pressure, activation of proinflammatory mediators, and direct nephrotoxicity are central in the pathogenesis of CPB-AKI. AKI after CPB is a well-known, and the clinicians should be more attention.Despite advances of endograft techniques, open thoracoabdominal aortic and vena cava surgeries are still used in patients unsuitable for endovascular repair. These procedures are usually associated with significant blood loss, which may result in hypovolemia or hypoxemia. Regionally reduced oxygen supply lead to physiologically low oxygen tensions within the renal cortex and the medulla and may cause postoperative AKI. and are associated with substantial incidence of postoperative AKI. The risk factors and outcomes of AKI after open thoracoabdominal aortic and vena cava surgeries were poorly addressed in the literatures.We conducted a retrospective review of the medical records of patients who underwent vascular surgeries and patients who were scheduled to heart valve surgery or coronary artery bypass grafting (CABG) with CPB technique at Peking Union Medical College Hospital.Purpose1、 To analyze the clinical characteristics of postoperative AKI, and the factors for AKI.2、 To lay a foundation for a further study, we combine basic and clinical research pre-designed prospective studies to evaluate prevention interventions AKI and to establish long-term follow-up of AKI cohort.MethodsA retrospective review of medical records of Peking Union Medical College Hospital was conducted. Patients who were scheduled to heart valve surgery or coronary artery bypass grafting (CABG) with CPB technique and underwent open thoracoabdominal aortic and vena cava surgeries. The primary analysis was between patients underwent open aorta and vena cava surgeryies, with or without postoperative AKI. AKI criteria from the Kidney Disease:Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury,2012. Multivariable logistic regression models were used to determine risk factors of postoperative AKI.Results1. The clinical characteristics of surgery patientsThe study population in cardiac surgery, with an average age of 57±12years (age 21 to 83). There were 54 (23.2%) diabetes patients,105(45.1%) hypertension patients,21(9%) chronic kidney disease (CKD) patients, and51(21.9%) anemia patients. Overall incidence of AKI was32.2%.A review of the medical records revealed 4926 cases of vascular surgery. A total of 79 cases met the inclusion criteria, accounting for 1.6%of the population. The mean age at the time of surgery was 52.5±17.3 years (range,17-81years). Among the patients,48.1% (38) had a medical history of hypertension, and the prevalence of CKD, coronary heart disease and diabetes were 11.4% (9),7.5% (6), and 2.5% (2), respectively.31 patients (39.2%) underwent open aortic aneurysm repair,16 patients (20.3%) underwent aortic bypass,8 patients (10.1%) underwent renal artery aneurysm repair,6 patients (7.6%) underwent inferior vena cava leiomyosarcoma resection, and 18 patients (22.8%) underwent other major vascular surgeries. Blood loss (ml) median 1000 (700,2000). AKI occurred in 23 (29.1%) of the patients.2. Analysis of the risk factors of AKIMultiariable Logistic regression suggests that basic CKD (OR=9.498, P=0.001), anemia (OR=3.150, P=0.021), the low LVEF before surgery (OR=1.733, P=0.045), intraoperative aortic block time (OR=2.227, P=0.026), and high white blood cell (OR=3.357, P=0.032) were the independent risk factors of AKI after CPB.Postoperative anemia (OR 3.778,95 CI (1.121 ～ 12.736)) was the independent risk factor of AKI.Conclusions1、 AKI is a common complication in patients who following cardiac surgery with CPB and undergo open thoracoabdominal aortic and vena cava surgeries.2、 More postoperative serum creatinine peak occurs within 48 hours after surgery, but AKI ocurred in two days after surgery was found having a certain proportion, which should be tanken seriously.3、 Evaluating and improving heart and kidney function before surgery. Reducing renal aortic cross-clamping time perhaps reduce the incidence of postoperative AKI.4、 Perioperative anemia is the most relevant predictive factor of AKI, Strategies to minimize bleeding and anemia for all patients may be advisable.