Incidence of acute kidney injury according to the KDIGO criteria in patients undergoing cardiac surgery: a prospective observational study

• Grant number: 18/18225-2
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: February 01, 2019
• End date: January 31, 2020
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Ludhmila Abrahão Hajjar
• Grantee: Juliana Bittencourt Cruz Salviano
• Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

Acute renal injury (AKI) is defined as a decrease in renal function leading to accumulation of nitrogenous products and metabolic residues and it is one of the main complications and causes of morbidity and mortality associated with cardiac surgery, with an incidence ranging from 8.9% to 39% and mortality ranging from 3.8% to 54.4%. [1;2;3;4] Worsening of renal function has been associated with short and long term effects after cardiac surgery, with clinical repercussions that may worsen the patient's prognosis. Some features of cardiac surgery such as extracorporeal circulation, aortic clamping, blood transfusion and high doses of vasopressors increase the risk of AKI, as they alter renal perfusion, increase oxidative stress, and systemic and renal inflammation. [5;6] For a more clear definition of AKI, Kidney Disease: Improving Global Outcomes (KDIGO) has been developed. Acute Kidney Injury Work, which covers previously used (AKIN and RIFLE). The KDIGO criterion defines acute renal injury according to altered serum creatinine and urinary output. It is characterized as a serum creatinine increase of 0.3 mg / dL over a 48-hour period and / or reduction of the glomerular filtration rate in 7 days or, reduction less than 0.5 mL / kg / h for 6 hours of urine output. Comparative studies between KDIGO and previous criteria demonstrate a greater number of diagnoses of AKI by KDIGO. [7] This project aims to identify the incidence of AKI through the KDIGO classification in patients undergoing cardiac surgery with CPB and to evaluate the association of the occurrence of this renal dysfunction with outcomes such as mortality after 1 year of the surgical procedure.Ad-hoc Working Group of ERBP, Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, Van Biesen W. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: Part 1: de nitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant. 2012; 27(12):4263-722. Howell NJ, Freemantle N, Bonser RS, Graham TR, Mascaro J, Rooney SJ, Wilson IC, Pagano D. Subtle changes in renal function are associated with differences in late survival following adult cardiac surgery. Eur J Cardiothorac Surg. 2012;41:e38-e42.3. Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15:1597-1605.4. Xu J, Jiang W, Fang Y, Teng J, Ding X. Management of cardiac surgery- associated acute kidney injury. Contrib Nephrol. 2016;187:131-142. 5. Yallop KG, Smith DC. The incidence and pathogenesis of acute renal failure following cardiac surgery, and strategies for its prevention. Ann Card Anaesth. 2004;7(1):17-31.6. Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, Dupuis JY, Fremes SE, Kent B, Laflamme C, Lamy A, Legare JF, Mazer CD, McCluskey SA, Rubens FD, Sawchuk C, Beattie WS. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009; 119(4):495-502. 7. Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Critical Care. 2014;18(4):R144.