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 Incidence and progression of cardiac surgery-associated acute kidney injury and its relationship with bypass and cross clamp time

Habib Md Reazaul Karim1, Mohd Yunus2, Manuj Kumar Saikia3, Jyoti Prasad Kalita3, Mrinal Mandal4
1 Department of Anaesthesiology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, India
2 Department of Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India
3 Department of Cardio Thoracic Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India
4 Perfusionist, Department of Cardio Thoracic Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India

Correspondence Address:
Mohd Yunus
North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Mawdiangdiang, Shillong - 793 018, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.197823

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Year : 2017  |  Volume : 20  |  Issue : 1  |  Page : 22-27

 
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Introduction: Cardiac surgery-associated kidney injury (CSA-AKI) is common but relatively less is known about its progression. The present study is aimed at evaluating the incidence and course of CSA-AKI and its relationship with the different durations of cardiopulmonary bypass (CPB) and cross clamp times. Materials and Methods : Occurrences of CSA-AKI are evaluated as per the Akin Kidney Injury Network (AKIN) criteria over the course of 5 postoperative day (POD) in 100 patients. The relationship of different durations of CPB and aortic cross clamp time with CSA-AKI is analyzed by Chi-squared test for trend and other appropriate tests using INSTAT software. Results: One hundred (43 male, 57 female; mean age of 37.01 ± 12.28 years, and baseline mean serum creatinine 0.99 ± 0.20 mg %) patients undergone mostly valve replacement, and congenital heart disease correction was evaluated. Nearly 49% suffered CSA-AKI (81.63% AKIN Class I) with maximum numbers on 2 nd POD. Serum creatinine followed a falling trend 3 rd POD onward except in 8.16% cases of CSA-AKI. Oliguria was absent even in AKIN Class II. The CPB time >70 min and cross clamp time >60 min increase CSA-AKI risk by an OR of 4.76 and 2.84, respectively (P < 0.05). Conclusion: CSA-AKI is very prevalent; mostly of AKIN Class I and increases with increasing CPB and cross clamp time. Urine output is not a reliable indicator of CSA-AKI. The AKIN Class II on the very 1 st POD or increasing trend of serum creatinine beyond 3 rd POD should alert for early intervention.






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Habib Md Reazaul Karim1, Mohd Yunus2, Manuj Kumar Saikia3, Jyoti Prasad Kalita3, Mrinal Mandal4
1 Department of Anaesthesiology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, India
2 Department of Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India
3 Department of Cardio Thoracic Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India
4 Perfusionist, Department of Cardio Thoracic Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India

Correspondence Address:
Mohd Yunus
North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Mawdiangdiang, Shillong - 793 018, Meghalaya
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.197823

Rights and Permissions

Introduction: Cardiac surgery-associated kidney injury (CSA-AKI) is common but relatively less is known about its progression. The present study is aimed at evaluating the incidence and course of CSA-AKI and its relationship with the different durations of cardiopulmonary bypass (CPB) and cross clamp times. Materials and Methods : Occurrences of CSA-AKI are evaluated as per the Akin Kidney Injury Network (AKIN) criteria over the course of 5 postoperative day (POD) in 100 patients. The relationship of different durations of CPB and aortic cross clamp time with CSA-AKI is analyzed by Chi-squared test for trend and other appropriate tests using INSTAT software. Results: One hundred (43 male, 57 female; mean age of 37.01 ± 12.28 years, and baseline mean serum creatinine 0.99 ± 0.20 mg %) patients undergone mostly valve replacement, and congenital heart disease correction was evaluated. Nearly 49% suffered CSA-AKI (81.63% AKIN Class I) with maximum numbers on 2 nd POD. Serum creatinine followed a falling trend 3 rd POD onward except in 8.16% cases of CSA-AKI. Oliguria was absent even in AKIN Class II. The CPB time >70 min and cross clamp time >60 min increase CSA-AKI risk by an OR of 4.76 and 2.84, respectively (P < 0.05). Conclusion: CSA-AKI is very prevalent; mostly of AKIN Class I and increases with increasing CPB and cross clamp time. Urine output is not a reliable indicator of CSA-AKI. The AKIN Class II on the very 1 st POD or increasing trend of serum creatinine beyond 3 rd POD should alert for early intervention.






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  © Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow
 Online since 5th January, 2008