Renal recovery and long-term survival following acute kidney injury after coronary artery surgery: a nationwide study

被引:34
|
作者
Helgadottir, S. [1 ]
Sigurdsson, M. I. [2 ]
Palsson, R. [3 ,4 ]
Helgason, D. [1 ]
Sigurdsson, G. H. [3 ,5 ]
Gudbjartsson, T. [1 ,3 ]
机构
[1] Landspitali Univ Hosp, Dept Cardiothorac Surg, IS-101 Reykjavik, Iceland
[2] Brigham & Womens Hosp, Dept Anesthesiol Perioperat & Pain Med, 75 Francis St, Boston, MA 02115 USA
[3] Univ Iceland, Fac Med, Reykjavik, Iceland
[4] Landspitali Univ Hosp, Dept Nephrol, Reykjavik, Iceland
[5] Landspitali Univ Hosp, Dept Anesthesia & Intens Care Med, Reykjavik, Iceland
关键词
CRITICALLY-ILL PATIENTS; CARDIAC-SURGERY; SERUM CREATININE; REPLACEMENT THERAPY; RISK-FACTORS; OUTCOMES; DISEASE; MORTALITY; TRANSFUSION; ASSOCIATION;
D O I
10.1111/aas.12758
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BackgroundAcute kidney injury (AKI) is a relatively common complication following CABG and is associated with adverse outcomes. Nonetheless, we hypothesized that the majority of patients make a good long-term recovery of their renal function. We studied the incidence and risk factors of AKI together with renal recovery and long-term survival in patients who developed AKI following CABG. MethodsThis nationwide study examined AKI among 1754 consecutive patients undergoing CABG in 2001-2013. AKI was defined according to the KDIGO criteria. ResultsPostoperatively 184 (11%) patients developed AKI; 121 (7%), 27 (2%), and 36 (2%) at stages 1, 2, and 3, respectively. AKI was an independent risk factor for chronic kidney disease (CKD) and AKI patients had worse post-operative outcomes. Lower pre-operative glomerular filtration rate, higher EuroSCORE and BMI, diabetes, reoperation, and units of red blood cells transfused were independent risk factors of AKI. At post-operative day 10, renal recovery rates, defined as serum creatinine ratio <1.25 of baseline, were 96 (95% CI 91-99%), 78 (95% CI 53-90%), and 94% (95% CI 77-98%) for AKI stages 1, 2, and 3, respectively. Long-term survival was predicted by AKI with 10-year survival of patients without AKI being 76% and those with AKI stages 1, 2, and 3 being 63%, 56%, and 49%, respectively (P < 0.001). ConclusionDepending on the severity of the initial AKI, 78-97% of patients made good recovery of their kidney function. However, AKI was significantly linked to progression to CKD and long-term survival remained markedly affected by the severity of the initial kidney injury.
引用
收藏
页码:1230 / 1240
页数:11
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