Acute Kidney Disease, Acute Kidney Injury
Conditions
Keywords
Acute kidney injury, Intraoperative hypotension, Central venous pressure, Acute kidney disease, Cardiopulmonary bypass
Brief summary
This study was aimed to explore the effect of intraoperative venous congestion and intraoperative hypotension (IOH) on acute adverse kidney events, defined as acute kidney injury (AKI) and acute kidney disease (AKD), after cardiac surgery
Detailed description
Venous congestion and IOH were primary exposures and quantified as area under the curve (AUC) of central venous pressure ≥12, 16 or 20 mmHg or mean arterial pressure ≤55, 65, 75 mmHg. The primary outcome was AKI or AKD defined as renal dysfunction persisting \> 7 days after surgery. Multivariable logistic regression and Cox proportional hazard models were used to determine the association between intraoperative venous congestion/hypotension and postoperative acute adverse kidney events, respectively, adjusted for relevant confounding factors and multiple comparisons.
Interventions
OTHERVenous congestion
Venous congestion exposures were quantified as area under the curve (AUC) of central venous pressure ≥12, 16 or 20 mmHg
OTHERIntroperation hypotension
Introperation hypotension exposures were quantified as area under the curve (AUC) of mean arterial pressure ≤55, 65, 75 mmHg
Sponsors
Nanjing First Hospital, Nanjing Medical University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 18 years and older, * Patients underwent cardiac surgery (coronary artery bypass grafting, heart valve surgery, heart transplant or surgical excision of intracardiac myxoma) * Patients receiving invasive intraoperative BP monitoring during surgery * Patients underwent cardiopulmonary bypass (CPB) during surgery
Exclusion criteria
* Pre-existing renal insufficiency defined by presence of abnormal preoperative serum creatinine ≥ 133 μmol/L and/or preoperative diagnosis of renal insufficiency within 6 months'preoperative period. * Patients with preoperative dialysis dependence within 60 days before the index surgical procedure, * Surgical duration less than 30 minutes * Surgery on the aorta * Insufficient hemodynamic and laboratory data for outcomes and/or exposure ascertainment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| CSA-AKI | 7 days post operation | Cardiovascular surgery associated acute kidney injury. AKI was defined using the Kidney Disease: Improving Global Outcome (KDIGO) Clinical Practice Guideline for Acute Kidney Injury as an absolute increase in serum creatinine of ≥ 26 μmol/L within 48 hours or an increase in serum creatinine beyond 1.5 times the baseline value within 7 days |
| AKD | 8 to 90 days post operation | Acute Kidney Disease, which was defined according to the criteria recommended by the Acute Disease Quality Initiative (ADQI) workgroup.4 AKI was quantified within the 7 days' postoperative period, while AKD was defined as serum creatinine value elevated to 1.5 times the baseline value between 8- and 90-day post-operation period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| value of eGFR | 7 days after operation | postoperative estimated glomerular filtration rate (eGFR), which was calculated by MDRD Equation. |
| inpatient mortality | 30 days after inhospital | mortality during hospital stay |
| Incidence of AKD of stage 2 and above | 8 to 90 days post operation | incidence of AKD of stage 2 and above, defined as increase in serum creatinine beyond 2.0 times the baseline value between 8- and 90-day post-operation period. |
| length of hospital stay | from the end of operation to the discharge from hospital, up to 90 days. | days stay in hospital |
| ICU length of stay | from the end of operation to the discharge from ICU, up to 90 days. | days stay in ICU |
| RRT initiation | from the end of operation to the discharge from hospital, up to 90 days. | renal replacement theray (RRT) initiation |
Countries
China
Outcome results
None listed