Volume-associated hemodynamic variables for prediction of cardiac surgery-associated acute kidney injury
- 1 September 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical and Experimental Nephrology
- Vol. 24 (9), 798-805
- https://doi.org/10.1007/s10157-020-01908-6
Abstract
Background Delayed diagnosis of acute kidney injury (AKI) is common because the changes in renal function markers often lag injury. We aimed to find optimal non-invasive hemodynamic variables for the prediction of postoperative AKI and AKI renal replacement therapy (RRT). Methods The data were collected from 1,180 patients who underwent cardiac surgery in our hospital between March 2015 and Feb 2016. Postoperative central venous pressure (CVP), mean arterial pressure (MAP), heart rate, PaO2, and PaCO2 on ICU admission and daily fluid input and output (calculated as 24 h PFO) were monitored and compared between AKI vs. non-AKI and RRT vs non-RRT cases. Results The AKI and AKI-RRT incidences were 36.7% (n = 433) and 1.2% (n = 14). Low cardiac output syndromes (LCOSs) occurred significantly more in AKI and RRT than in non-AKI or non-RRT groups (13.2% vs. 3.9%, P < 0.01; 42.9% vs. 7.1%, P < 0.01). CVP on ICU admission was significantly higher in AKI and RRT than in non-AKI and non-RRT groups (11.5 vs. 9.0 mmHg, P < 0.01; 13.3 vs. 9.9 mmHg, P < 0.01). 24 h PFO in AKI and RRT cases were significantly higher than in non-AKI or non-RRT patients (1.6% vs. 0.9%, P < 0.01; 3.9% vs. 0.8%, P < 0.01). The areas under the ROC curves to predict postoperative AKI by CVP on ICU admission (> 11 mmHg) + LCOS + 24 h PFO (> 5%) and to predict AKI-RRT by CVP on ICU admission (> 13 mmHg) + LCOS + 24 h PFO (> 5%) were 0.763 and 0.886, respectively. Conclusion The volume-associated hemodynamic variables, including CVP on ICU admission, LCOS, and 24 h PFO after surgery could predict postoperative AKI and AKI-RRT.Funding Information
- National Natural Science Foundation of China (81901939)
- Shanghai Key Laboratory of Kidney and Blood Purification (14DZ2260200)
- Shanghai “science and technology innovation plan” popular science project (19DZ2321400)
- Xiamen Science and Technology Plan in 2018 (3502Z20184009)
- Shanghai Clinical Medical Center for Kidney Disease Project support by Shanghai Municipal Health Commission (2017ZZ01015)
This publication has 30 references indexed in Scilit:
- Short-term independent mortality risk factors in patients with cirrhosis undergoing cardiac surgeryInteractive CardioVascular and Thoracic Surgery, 2012
- NoticeKidney International Supplements, 2012
- Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality*Critical Care Medicine, 2011
- Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart FailureJournal of the American College of Cardiology, 2009
- Review of A Large Clinical Series: Association of Cumulative Fluid Balance on Outcome in Acute Lung Injury: A Retrospective Review of the ARDSnet Tidal Volume Study CohortJournal of Intensive Care Medicine, 2008
- Mechanics of the left ventricular myocardial interstitium: effects of acute and chronic myocardial edemaAmerican Journal of Physiology-Heart and Circulatory Physiology, 2008
- Venous Function and Central Venous PressureAnesthesiology, 2008
- A positive fluid balance is associated with a worse outcome in patients with acute renal failureCritical Care, 2008
- Role of Diminished Renal Function in Cardiovascular Mortality: Marker or Pathogenetic Factor?Journal of the American College of Cardiology, 2006
- Effect of fluid overload and dose of replacement fluid on survival in hemofiltrationPediatric Nephrology, 2004