Cardiac Surgery–Related Acute Kidney Injury _ Risk Factors, Clinical Course, Management Suggestions

Objective: Acute kidney injury (AKI) is a common complication after cardiac surgery (CS). Because a therapeutic regimen remains scarce, the early implementation of preventive strategies is crucial. The authors investigated risk factors and the typical clinical course of CS-associated AKI (CS-AKI) to derive strategies for perioperative clinical routines. Design: Retrospective data analysis. Setting: The data were collected from clinical routines in a maximum care university hospital. Participants: Patients. Interventions: The authors retrospectively analyzed data from 538 patients who underwent CS. Measurements and Main Results: The median age of the 466 patients included was 66.6 years; 65.7% were men. AKI occurred in 131 (28.1%) patients, mainly (89.0%) starting postoperatively within 72 hours p. Thirty-one (6.7%) patients showed Kidney Disease Improving Global Out-come AKI stage 3. AKI was significantly more frequent in patients with chronic kidney disease (p < 0.001), emergency admission (p < 0.001), heart failure (p < 0.001), and postoperative complications (p < 0.001). In a multivariate analysis, postoperative CS-AKI risk significantly decreased with each 1 or 10 mL/min preoperative glomerular filtration rate (GFR) (odds ratio, 0.962 and 0.677; 95% confidence interval, 0.947-0.977 and 0.577-0.793; p < 0.001 and p < 0.0001). Only in patients who developed Kidney Disease Improving Global Outcome AKI stage 3, an early postoperative trend to decreased GFR and increased creatinine levels was observed. Conclusions: Especially in patients with preexisting CKD and signs of CS-AKI occurring on the day of surgery, close monitoring of renal func-tion should be performed for at least 72 hours after CS to detect an onset of AKI early and initiate renal protective strategies. Optimal preopera-tive fluid management might prevent postoperative AKI. (C) 2021 Elsevier Inc. All rights reserved.