Abstract

Acute kidney injury after open heart surgery in seyyed-al-Shohad heart center urmia(Iran)

Author(s):Khademvatani K, Seyyed Mohammad ZadM. H, Alinejad V, Abkhiz S4,Mehdi zadeh H and Mahmoudi Sheikh-Sarmast A

Cardiac surgery-associated acute kidney injury (CSA-AKI)is a serious, well known medical problem with significant morbidity and marked predisposition to mortality in 9-45% of patients undergoing cardiac surgeries. Clinical studies have identified several risk factors for AKI that can be used to determine effectively the risk for AKI in patients who undergo coronary bypass grafts. These high risk patients then can be targeted for more kidneys protective enterprises before cardiac surgeries. This prospective case-control study enrolled 203 adult (> 18 years of age) patients whom underwent on-pump cardiac surgeries at seyyed-ol-shohada heart center of Urmia From September 1, 2013 to March 1, 2014. CSA-AKI defined as 50% increase in the plasma creatinine concentration during 7 postoperative days compared to the baseline value and by 25% decrease in glomerular filtration rate or a urine output less than 0.5 mL kg -1 per hour for more than 6 h (according to the criteria of the Risk Injury Failure Loss End-Stage Renal Disease(RIFLE).Patients divided into two groups, based on outcome, patients who developed CSA-AKI as cases group and patients who didn’t developed CSA-AKI as controls group. Statistical analysis performed using SPSS program (version 18, Chicago, IL, USA). Kaplan Meier, T-test and log linear tests used to compare variables between cases and controls. The incidence of CSA-AKI was 23.2%.Among 47 patients with CSAAKI, 42 patients detected with CSA-AKI Stage 1, 4 patients with stage 2 and 1 person with stage 3.The mean age of patients was 59.85 ± 10.65 years (minimum age 18, maximum age 81 years). The mean age of the patients with CSA-AKI is equal to 61.45 ± 9.27 years and the mean age of patients who had not CSA-AKI is equal to 59.37 ± 11.01 years. Preoperative and intraoperative variables that were associated with the development of CSA-AKI included:preoperative LVEF<35%(p=0.017),needs to infusion of inotropic drugs(P=0.001),type of surgery(p=0.044),reoperation(p = 0.071)The following factors weren't associated with the development of CSI-AKI: Diabetes Mellitus (p = 0.809),hypertension(p = 0.210),smoking (p = 0.573),intake of diuretic drugs(p = 0.876),mean of Hematocrit during surgery(p = 0.632),gender difference(p = 0.332) ,reeintubation((p = 0.548). There is significant difference between postoperative mortality and incidence of CSA-AKI at 95% (p = 0.010).Our conclusion is the development of CSA-AKI is associated with a high mortality. We have identified perioperative risk factors, which may be useful in reducing of risk for the development of CSA-AKI. _____________________________________________________________________________________________

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