Cardiopulmonary bypass management and acute kidney injury in cardiac surgery patients

被引:1
作者
Barbu, Mikael [1 ,2 ,10 ]
Hjarpe, Anders [3 ,4 ]
Martinsson, Andreas [1 ,5 ]
Dellgren, Goran [1 ,6 ]
Ricksten, Sven-Erik [3 ]
Lannemyr, Lukas [3 ,7 ]
Pivodic, Aldina [8 ,9 ]
Taha, Amar [1 ,5 ]
Jeppsson, Anders [1 ,4 ]
机构
[1] Univ Gothenburg, Inst Med, Sahlgrenska Acad, Dept Mol & Clin Med, Gothenburg, Sweden
[2] Blekinge Hosp, Dept Cardiol, Karlskrona, Sweden
[3] Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Anesthes & Intens Care, Gothenburg, Sweden
[4] Sahlgrens Univ Hosp, Dept Cardiothorac Surg, Gothenburg, Sweden
[5] Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden
[6] Sahlgrens Univ Hosp, Transplant Inst, Gothenburg, Sweden
[7] Sahlgrens Univ Hosp, Dept Cardiothorac Anesthesiol & Intens Care, Gothenburg, Sweden
[8] APNC Sweden, Gothenburg, Sweden
[9] Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, Dept Clin Neurosci, Gothenburg, Sweden
[10] Blekinge Hosp, Dept Cardiol, S-37141 Karlskrona, Sweden
关键词
acute kidney injury; cardiac surgery; cardiopulmonary bypass; MORTALITY; HEMODILUTION; OXYGENATION; FILTRATION; PERFUSION; OUTCOMES;
D O I
10.1111/aas.14357
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Cardiopulmonary bypass (CPB) ensures tissue oxygenation during cardiac surgery. New technology allows continuous registration of CPB variables during the operation. The aim of the present investigation was to study the association between CPB management and the risk of postoperative acute kidney injury (AKI).Methods: This observational study based on prospectively registered data included 2661 coronary artery bypass grafting and/or valve patients operated during 2016-2020. Individual patient characteristics and postoperative outcomes collected from the SWEDEHEART registry were merged with CPB variables automatically registered every 20 s during CPB. Associations between CPB variables and AKI were analyzed with multivariable logistic regression models adjusted for patient characteristics.Results: In total, 387 patients (14.5%) developed postoperative AKI. After adjustments, longer time on CPB and aortic cross-clamp, periods of compromised blood flow during aortic cross-clamp time, and lower nadir hematocrit were associated with the risk of AKI, while mean blood flow, bladder temperature, central venous pressure, and mixed venous oxygen saturation were not. Patient characteristics independently associated with AKI were advanced age, higher body mass index, hypertension, diabetes mellitus, atrial fibrillation, lower left ventricular ejection fraction, estimated glomerular filtration rate <60 or >90 mL/min/m(2) , and preoperative hemoglobin concentration below or above the normal sex-specific range.Conclusions: To reduce the risk of AKI after cardiac surgery, aortic clamp time and CPB time should be kept short, and low hematocrit and periods of compromised blood flow during aortic cross-clamp time should be avoided if possible.
引用
收藏
页码:328 / 336
页数:9
相关论文
共 24 条
  • [1] MECHANISMS OF DISEASE - HYPOXIA OF THE RENAL MEDULLA - ITS IMPLICATIONS FOR DISEASE
    BREZIS, M
    ROSEN, S
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1995, 332 (10) : 647 - 655
  • [2] Glomerular hyperfiltration
    Cortinovis, Monica
    Perico, Norberto
    Ruggenenti, Piero
    Remuzzi, Andrea
    Remuzzi, Giuseppe
    [J]. NATURE REVIEWS NEPHROLOGY, 2022, 18 (07) : 435 - 451
  • [3] Association of Glomerular Hyperfiltration and Cardiovascular Risk in Middle-Aged Healthy Individuals
    Dupuis, Marie-Eve
    Nadeau-Fredette, Annie-Claire
    Madore, Francois
    Agharazii, Mohsen
    Goupil, Remi
    [J]. JAMA NETWORK OPEN, 2020, 3 (04) : E202377
  • [4] Pathophysiology of Cardiopulmonary Bypass: Current Strategies for the Prevention and Treatment of Anemia, Coagulopathy, and Organ Dysfunction
    Esper, Stephen A.
    Subramaniam, Kathirvel
    Tanaka, Kenichi A.
    [J]. SEMINARS IN CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2014, 18 (02) : 161 - 176
  • [5] Risk factors and treatment of oxygenator high-pressure excursions during cardiopulmonary bypass
    Hjarpe, Anders Karl
    Jeppsson, Anders
    Lannemyr, Lukas
    Lindgren, Martin
    [J]. PERFUSION-UK, 2023, 38 (01): : 156 - 164
  • [6] Global Incidence and Outcomes of Adult Patients With Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-Analysis
    Hu, Jiachang
    Chen, Rongyi
    Liu, Shaopeng
    Yu, Xiaofang
    Zou, Jianzhou
    Ding, Xiaoqiang
    [J]. JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2016, 30 (01) : 82 - 89
  • [7] The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART)
    Jernberg, Tomas
    Attebring, Mona F.
    Hambraeus, Kristina
    Ivert, Torbjorn
    James, Stefan
    Jeppsson, Anders
    Lagerqvist, Bo
    Lindahl, Bertil
    Stenestrand, Ulf
    Wallentin, Lars
    [J]. HEART, 2010, 96 (20) : 1617 - 1621
  • [8] Karim HMR, 2017, ANN CARD ANAESTH, V20, P22, DOI 10.4103/0971-9784.197823
  • [9] Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery
    Karkouti, K
    Beattie, WS
    Wijeysundera, DN
    Rao, V
    Chan, C
    Dattilo, KM
    Djaiani, G
    Ivanov, J
    Karski, J
    David, TE
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2005, 129 (02) : 391 - 400
  • [10] Acute Kidney Injury After Cardiac Surgery Focus on Modifiable Risk Factors
    Karkouti, Keyvan
    Wijeysundera, Duminda N.
    Yau, Terrence M.
    Callum, Jeannie L.
    Cheng, Davy C.
    Crowther, Mark
    Dupuis, Jean-Yves
    Fremes, Stephen E.
    Kent, Blaine
    Laflamme, Claude
    Lamy, Andre
    Legare, Jean-Francois
    Mazer, C. David
    McCluskey, Stuart A.
    Rubens, Fraser D.
    Sawchuk, Corey
    Beattie, W. Scott
    [J]. CIRCULATION, 2009, 119 (04) : 495 - 502