Patients with chronic kidney disease susceptible to AKI following cardiac surgery

China: The prevalence of cardiac surgery-associated acute kidney injury (CSA-AKI) was high in patients with chronic kidney disease (CKD) which led to a negative impact on both the prognosis for the kidneys and general health, says an article published in the Karger journal Blood Purification. 

One of the most frequent side effects of cardiac surgery is cardiac surgery-associated acute kidney damage (CSA-AKI), and patients with chronic kidney disease who develop CSA-AKI have a very bad prognosis for their kidneys and overall health. However, there is not much-published data on the prevalence of CSA-AKI in CKD patients. As a result, Zhang D. and colleagues conducted a study to look into the risk factors and predictive variables of AKI connected to heart surgery in patients with CKD.

For this investigation, CKD patients who underwent heart surgery at a tertiary referral teaching hospital were the subjects of a retrospective study. KDIGO criteria were used to define CSA-AKI. Investigations were conducted into the risk factors for CSA-AKI and the variables influencing renal function recovery at discharge or patient mortality in cases of AKI.

The key findings of this study were:

1. The frequency of CSA-AKI among the 1638 CKD patients recruited was 50.55%.

2. In-hospital mortality was greater for AKI patients compared to non-AKI patients (AKI vs. no AKI, 4.7 vs. 0.9%).

3. Male gender, preoperative hypertension (OR 1.548), preoperative hemoglobin of 110 g/L (OR 2.389), and aortic clamping time >58 min (OR 1.567) were distinct risk factors for AKI following cardiac surgery in patients with CKD, according to multivariate logistic regression analysis.

4. Hyperchloremia (OR 0.927), preoperative diabetes mellitus (OR 0.306), estimated glomerular filtration rate (OR 1.034), and AKI development all had an impact on the recovery of renal function in AKI patients.

5. Patients with AKI stage 2 and stage 3 recovered renal function at rates that were 78.9% and 82.3% slower than those with AKI stage 1, respectively.

In conclusion, the prognosis of individuals with CKD undergoing cardiac surgeries may be improved by early management of modifiable variables.

Reference: 

Zhang, D., Teng, J., Luo, Z., Ding, X., & Jiang, W. (2022). Risk Factors and Prognosis of Acute Kidney Injury after Cardiac Surgery in Patients with Chronic Kidney Disease. In Blood Purification (pp. 1–8). S. Karger AG. https://doi.org/10.1159/000526120