Cardiac Surgery Associated - Acute Kidney Injury, Critical Illness
Conditions
Keywords
Acute kidney injury, Biomarker, Poor outcome, AKI occurrence, Prognostic value, Cardiac Surgery Associated - Acute Kidney Injury
Brief summary
This project aims to detect novel biomarkers from preoperative and early postoperative serum and urine samples of patients to screen and analyze the risk factors for predicting adverse postoperative renal outcomes in high-risk patients in cardiac surgery.
Detailed description
This project will prospectively collect all high-risk individuals who underwent cardiac surgery, collect medical history, laboratory data and specimen test results, and test biomarkers in blood and urine specimens. Previously identified candidate biomarkers include the tumor necrosis factor-like weak inducer of apoptosis receptor (TWEAKR), galectin-9 (Gal-9), perilipin-2 (Plin2), and CCN family member 1, among others. The occurrence of postoperative AKI will be the primary endpoint of the study. The variable factors that can be used to predict and warn the main research endpoints at an early stage were screened through methods such as logistic regression, and their non-inferiority compared with traditional markers was tested. This study will facilitate early clinical identification and early warning of AKI, early implementation of preventive measures and intervention strategies, thereby improving the prognosis of patients and improve the overall safety and success rate of cardiac surgery.
Interventions
The management for AKI patients were performed by implementing a standard care "bundle" suggested by the Kidney Disease Improving Global Outcome (KDIGO) guideline.
Sponsors
Guowei Tu
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
Adult patients were included in the study if they were scheduled for elective open chest cavity cardiac surgeries, with or without the use of cardiopulmonary bypass (CPB). Inclusion criteria required that patients undergoing surgery with CPB must have at least one AKI risk factor, whereas those undergoing surgery without CPB needed to have at least two AKI risk factors. The AKI risk factors were as follows: * age \>70 years; * 30 \< estimated glomerular filtration rate (eGFR) \<60 mL·min-1·1.73 m-2; * diabetes mellitus, proteinuria; * a history of congestive heart failure within the previous year; * a left ventricular ejection fraction of 40% or lower; * prior cardiac surgery; * combined coronary artery bypass/valve procedure; * urgent procedure; * preoperative intra-aortic balloon pump.
Exclusion criteria
* pre-existing chronic kidney disease (preoperative estimated glomerular filtration rate \[eGFR\] \< 30 mL/min/1.73 m2); * previous RRT before cardiac surgery; * present AKI at screening; * a history of kidney transplant or other kidney diseases; * known pregnancy; * multiple operation during the hospital stay; * being in a moribund state (with an anticipated likelihood of death within 48 hours).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| AKI occurrence within 7 days | 7 days | AKI was defined based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Moderate and severe AKI occurrence within 7 days | 7 days | Stage 2 and stage 3 AKI based on KDIGO criteria. |
| AKI occurrence within 48 hours | 48 hours | AKI was defined based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. |
| AKI occurrence within 3 days | 3 days | AKI was defined based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. |
| Major adverse kidney events | Perioperative | MAKE at discharge MAKE was defined as the composite of≥25% loss in estimated glomerular filtration rate (eGFR), dialysis, or death. Estimated GFR was calculated from serum creatinine using the MDRD equation. |
| Receipt of renal replacement treatment | Perioperative | Patients received renal replacement therapy after being diagnosed with AKI. |
| Mortality | 30 days | Mortality at 30 days |
| length of stay in the ICU | Perioperative | length of stay in the ICU |
| Length of stay in the hospital | Perioperative | Length of stay in the hospital |
| The number of days of use and cumulative dose of vasoactive drugs | Perioperative | The number of days of use and cumulative dose of vasoactive drugs during ICU stay. |
| AKI on CKD | Perioperative | Number of patients with CKD develop AKI after surgery |
Countries
China
Contacts
CONTACTGuo wei Tu, MD
CONTACTYing Su, MD
STUDY_DIRECTORZhe Luo, MD
Fudan University
Outcome results
None listed