4 research outputs found
Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study
Acute kidney injury is among the most serious complications after
cardiac surgery and is associated with an impaired outcome. Multiple factors may
concur in the development of this disease. Moreover, severe renal failure
requiring renal replacement therapy (RRT) presents a high mortality rate.
Consequently, we studied a Spanish cohort of patients to assess the risk factors
for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI). METHODS: A
retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after
cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients
based on age, sex, treated in the same year, at the same hospital and by the same
group of surgeons. RESULTS: We analyzed the data from 864 patients enrolled in
2007. In multivariate analysis, severe acute kidney injury requiring
postoperative RRT was significantly associated with the following variables:
lower glomerular filtration rates, less basal haemoglobin, lower left ventricular
ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer
aortic cross clamp times, intraoperative administration of aprotinin, and
increased number of packed red blood cells (PRBC) transfused. When we conducted a
propensity analysis using best-matched of 137 available pairs of patients, prior
diuretic treatment, longer aortic cross clamp times and number of PRBC transfused
were significantly associated with CSA-AKI.Patients requiring RRT needed longer
hospital stays, and suffered higher mortality rates. CONCLUSION: Cardiac-surgery
associated acute kidney injury requiring RRT is associated with worse outcomes.
For this reason, modifiable risk factors should be optimised and higher risk
patients for acute kidney injury should be identified before undertaking cardiac
surgery
Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study
The aim of this study is to evaluate the association between acute
serum creatinine changes in acute renal failure (ARF), before specialized
treatment begins, and in-hospital mortality, recovery of renal function, and
overall mortality at 6 months, on an equal degree of ARF severity, using the
RIFLE criteria, and comorbid illnesses. METHODS: Prospective cohort study of 1008
consecutive patients who had been diagnosed as having ARF, and had been admitted
in an university-affiliated hospital over 10 years. Demographic, clinical
information and outcomes were measured. After that, 646 patients who had
presented enough increment in serum creatinine to qualify for the RIFLE criteria
were included for subsequent analysis. The population was divided into two groups
using the median serum creatinine change (101%) as the cut-off value.
Multivariate non-conditional logistic and linear regression models were used.
RESULTS: A >or= 101% increment of creatinine respect to its baseline before
nephrology consultation was associated with significant increase of in-hospital
mortality (35.6% vs. 22.6%, p < 0.001), with an adjusted odds ratio of 1.81 (95%
CI: 1.08-3.03). Patients who required continuous renal replacement therapy in the
>or= 101% increment group presented a higher increase of in-hospital mortality
(62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI:
1.00-7.21). Patients in the >or= 101% increment group had a higher mean serum
creatinine level with respect to their baseline level (114.72% vs. 37.96%) at
hospital discharge. This was an adjusted 48.92% (95% CI: 13.05-84.79) more serum
creatinine than in the < 101% increment group. CONCLUSION: In this cohort,
patients who had presented an increment in serum level of creatinine of >or= 101%
with respect to basal values, at the time of nephrology consultation, had
increased mortality rates and were discharged from hospital with a more
deteriorated renal function than those with similar Liano scoring and the same
RIFLE classes, but with a < 101% increment. This finding may provide more
information about the factors involved in the prognosis of ARF. Furthermore, the
calculation of relative serum creatinine increase could be used as a practical
tool to identify those patients at risk, and that would benefit from an intensive
therapy