Postoperative Blood Transfusion is an Independent Predictor of Acute Kidney Injury in Cardiac Surgery Patients

Overview

Journal J Nephropathol

Specialty Nephrology

Date 2015 Oct 13

PMID 26457259

Citations 18

Authors

Kristofer Freeland

Alireza Hamidian Jahromi

Lucas Maier Duvall

Mary Catherine Mancini

Affiliations

Soon will be listed here.

Abstract

Background: Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB) which increases postoperative morbidity and mortality.

Objectives: The study was designed to assess the incidence of AKI and associated risk factors in patients undergoing CPB ancillary to coronary artery bypass grafting (CABG), valve surgery, and combined CABG and valve surgery.

Patients And Methods: This Intuitional Review Board (IRB) approved retrospective study included patients with normal preoperative kidney function (Serum creatinine [sCr] <2.0 mg/dl) who underwent cardiac surgery with CPB between 2012 and 2014. Patients were divided into 2 groups: group I: Patients with cardiac surgery associated AKI (CS-AKI) (postoperative sCr >2 mg/dl with a minimal doubling of baseline sCr) and group II: Patients with a normal postoperative kidney function. Demographic data, body mass index (BMI), co-morbidities, hematologic/biochemical profiles, preoperative ejection fraction (%EF), blood transfusion history, and operative data were compared between the groups. Mean arterial pressure (MAP) was recorded during the operation and in the postoperative period. Δ-MAP was defined as the difference between pre-CPB-MAP and the CPB-MAP.

Results: 241 patients matched the inclusion criteria (CS-AKI incidence = 8.29%). Age, gender, BMI, %EF, and co-morbidities were not predictors of CS-AKI (P > 0.05). High preoperative sCr (P = 0.047), type of procedure (P = 0.04), clamp time (P = 0.003), pump time (P = 0.005) and history of blood transfusion within 14 days postsurgery (P = 0.0004) were associated with risk of CS-AKI. Pre-CPB-MAP, CPB-MAP, Δ-MAP, and ICU-MAP were not significantly different between the 2 groups. Male gender (OR: 5.53; P = 0.048), age>60 (OR: 4.54; P = 0.027) and blood transfusion after surgery (OR: 5.25; P = 0.0054) were independent predictors for postoperative AKI.

Conclusions: Age, gender and blood transfusion were independent predictors of cardiac surgery associated AKI.

Citing Articles

Significant reduction in blood product usage, same early outcomes: Blood conservation in infants undergoing open heart surgery.

Bohuta L, Chan T, Charette K, Latham G, Greene C, Mauchley D JTCVS Open. 2025; 22():450-457.

PMID: 39780805 PMC: 11704574. DOI: 10.1016/j.xjon.2024.10.006.

The Effect of Varying Preoperative Hemoglobin Levels on the Risk of Major Complications and Surgical Site Infections After Single Level Lumbar Fusion.

Haft M, Levy H, Agarwal A, Quan T, Greenberg M, Raad M J Am Acad Orthop Surg Glob Res Rev. 2024; 8(7).

PMID: 38996218 PMC: 11239155. DOI: 10.5435/JAAOSGlobal-D-24-00074.

Effect of albumin usage during cardiopulmonary bypass on postoperative acute kidney injury in cardiac surgery patients: A historical cohort study.

Khademi S, Heirany F, Jouybar R, Dehghanpisheh L, Ghazinoor M, Mehr L Ann Card Anaesth. 2023; 26(3):288-294.

PMID: 37470527 PMC: 10451135. DOI: 10.4103/aca.aca_84_22.

Effects of Pooled Platelet Concentrate After Coronary Artery Bypass Graft Surgery in Patients With Dual Antiplatelet Therapy.

Kaya K, Mungan U Tex Heart Inst J. 2023; 50(3).

PMID: 37170637 PMC: 10353283. DOI: 10.14503/THIJ-22-7864.

What is the optimal time interval between heart catheterization and surgery to prevent acute kidney injury in patients with isolated coronary artery bypass?.

Gorur D, Saskin H, Duzyol C Postepy Kardiol Interwencyjnej. 2022; 18(2):137-145.

PMID: 36051840 PMC: 9421509. DOI: 10.5114/aic.2022.118157.

References

Haase M, Bellomo R, Story D, Letis A, Klemz K, Matalanis G . Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney injury. Nephrol Dial Transplant. 2011; 27(1):153-60. DOI: 10.1093/ndt/gfr275. View

Kanji H, Schulze C, Hervas-Malo M, Wang P, Ross D, Zibdawi M . Difference between pre-operative and cardiopulmonary bypass mean arterial pressure is independently associated with early cardiac surgery-associated acute kidney injury. J Cardiothorac Surg. 2010; 5:71. PMC: 2941753. DOI: 10.1186/1749-8090-5-71. View

Vellinga S, Verbrugghe W, De Paep R, Verpooten G, Janssen van Doorn K . Identification of modifiable risk factors for acute kidney injury after cardiac surgery. Neth J Med. 2012; 70(10):450-4. View

Alsabbagh M, Asmar A, Ejaz N, Aiyer R, Kambhampati G, Ejaz A . Update on clinical trials for the prevention of acute kidney injury in patients undergoing cardiac surgery. Am J Surg. 2013; 206(1):86-95. DOI: 10.1016/j.amjsurg.2012.08.007. View

Mao H, Katz N, Ariyanon W, Blanca-Martos L, Adybelli Z, Giuliani A . Cardiac surgery-associated acute kidney injury. Cardiorenal Med. 2014; 3(3):178-199. PMC: 3884176. DOI: 10.1159/000353134. View

Antunes P, Prieto D, Ferrao de Oliveira J, Antunes M . Renal dysfunction after myocardial revascularization. Eur J Cardiothorac Surg. 2004; 25(4):597-604. DOI: 10.1016/j.ejcts.2004.01.010. View

Azau A, Markowicz P, Corbeau J, Cottineau C, Moreau X, Baufreton C . Increasing mean arterial pressure during cardiac surgery does not reduce the rate of postoperative acute kidney injury. Perfusion. 2014; 29(6):496-504. DOI: 10.1177/0267659114527331. View

Karkouti K, Wijeysundera D, Yau T, Callum J, Cheng D, Crowther M . Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009; 119(4):495-502. DOI: 10.1161/CIRCULATIONAHA.108.786913. View

Mangano C, Diamondstone L, Ramsay J, Aggarwal A, Herskowitz A, Mangano D . 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. DOI: 10.7326/0003-4819-128-3-199802010-00005. View

10.

Ranucci M, Ballotta A, Agnelli B, Frigiola A, Menicanti L, Castelvecchio S . Acute kidney injury in patients undergoing cardiac surgery and coronary angiography on the same day. Ann Thorac Surg. 2012; 95(2):513-9. DOI: 10.1016/j.athoracsur.2012.09.012. View

11.

Mitter N, Shah A, Yuh D, Dodd-O J, Thompson R, Cameron D . Renal injury is associated with operative mortality after cardiac surgery for women and men. J Thorac Cardiovasc Surg. 2010; 140(6):1367-73. PMC: 2904436. DOI: 10.1016/j.jtcvs.2010.02.021. View

12.

Karkouti K, Wijeysundera D, Yau T, McCluskey S, Chan C, Wong P . Advance targeted transfusion in anemic cardiac surgical patients for kidney protection: an unblinded randomized pilot clinical trial. Anesthesiology. 2012; 116(3):613-21. DOI: 10.1097/ALN.0b013e3182475e39. View

13.

Parida S, Badhe A . Cardiac surgery-associated acute kidney injury. J Anesth. 2012; 27(3):433-46. DOI: 10.1007/s00540-012-1523-2. View

14.

Mariscalco G, Lorusso R, Dominici C, Renzulli A, Sala A . Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg. 2011; 92(4):1539-47. DOI: 10.1016/j.athoracsur.2011.04.123. View

15.

Karkouti K . Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth. 2012; 109 Suppl 1:i29-i38. DOI: 10.1093/bja/aes422. View