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Predictors for aki in a cardiac surgery population undergoing cardio-pulmonary bypass

  • F Ramakers
  • Q Swennen
  • V Pennemans
  • J Penders
  • M Vander Laenen
  • W Boer
Open Access
Poster presentation
  • 174 Downloads

Keywords

Renal Insufficiency Urine Output Baseline Patient Common Diagnosis Kidney Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Introduction

In cardiac surgery involving cardio-pulmonary bypass, AKI is a relatively common diagnosis. In recent years a number of new biomarkers have been undergoing validation in this clinical setting. It is thought that earlier detection of AKI will offer opportunities for new therapeutic interventions

Objectives

Analysis of a database was performed to define baseline patient and biomarker characteristics in patients developing AKI in a population of cardiac surgery patients undergoing cardiopulmonary bypass as part of the procedure.

Methods

In total, 259 patients were enrolled, after the exclusion of patients with severe pre-existing renal insufficiency (defined as a eGFR< 15 ml/min). As part of a broader study, urine and blood samples were obtained immediately before initiation of cardio-pulmonary bypass. Patients were subsequently retrospectively divided into 2 groups, AKI (n=84) and non-AKI (n=175). This subdivision was based on based on the AKIN criteria i.e. increase in s-Creat ≥ 0.3 mg/dl or ≥ 50% compared to baseline within 48 h or reduction in urine output < 0.5 ml/kg/h for more than 6 h. Statistical analysis of all characteristics before arrival on the ICU was performed.

Results

AKI patients (32% of total) were older (70 yrs (SD = 9) vs 67 (11), p =0.043) with higher BMI´s (27.7 (4.8) vs.26.7 (4.3), p = 0.036). As to be expected baseline eGFR (CKD-EPI, in ml/min) was lower in the AKI-group (69.49 (20.30) vs. 76.45 (15.01), p = 0.024). Both baseline urinary-NGAL (µg/l)(1211 (2172) vs.749 (946), p = 0.020) and serum-cystatin C (in mg/L)(0.98 (0.39) vs 0.86 (0.36), p = 0.0175) were statistically higher in the AKI group and CPB time (in minutes) was significantly longer: 163 (63) vs 121 (51), p < 0.0001.

Conclusions

Urinary-NGAL and serum-Cystatin most likely reflect pre-existing kidney dysfunction (like eGFR). Length of cardiopulmonary bypass time is a significant factor for development of AKI, which is amenable to improvement.

References

  1. 1.
    Thiele RH, Isbell JM, Rosner MH: AKI Associated with Cardiac Surgery. Clin J Am Soc Nephrol. 2015, 10 (3): 500-514. 10.2215/CJN.07830814. Mar 6PubMedCrossRefGoogle Scholar

Copyright information

© Ramakers et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • F Ramakers
    • 1
  • Q Swennen
    • 2
  • V Pennemans
    • 2
  • J Penders
    • 2
  • M Vander Laenen
    • 1
  • W Boer
    • 1
  1. 1.Intensive Care and AnaesthesiologyZiekenhuis Oost LimburgGenkBelgium
  2. 2.Biomedical Research InstituteUHasseltDiepenbeekBelgium

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