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(Circulation. 2009;119:495-502.)
© 2009 American Heart Association, Inc.

Cardiovascular Surgery

Acute Kidney Injury After Cardiac Surgery

Focus on Modifiable Risk Factors

Keyvan Karkouti, MD; Duminda N. Wijeysundera, MD; Terrence M. Yau, MD; Jeannie L. Callum, MD; Davy C. Cheng, MD; Mark Crowther, MD; Jean-Yves Dupuis, MD; Stephen E. Fremes, MD; Blaine Kent, MD; Claude Laflamme, MD; Andre Lamy, MD; Jean-Francois Legare, MD; C. David Mazer, MD; Stuart A. McCluskey, MD; Fraser D. Rubens, MD; Corey Sawchuk, MD; W. Scott Beattie, MD

From the Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto (K.K., D.N.W., S.A.M., W.S.B.); Department of Health Policy, Management, and Evaluation, University of Toronto (K.K.); Department of Surgery, Division of Cardiac Surgery, Toronto General Hospital, University Health Network, University of Toronto (T.M.Y.); Department of Clinical Pathology; Sunnybrook Health Sciences Center; University of Toronto (J.L.C.), Toronto, Ontario, Canada; Department of Anesthesia, University of Western Ontario, London, Ontario, Canada (D.C.C.); Department of Medicine, Division of Hematology, McMaster University, Hamilton, Ontario, Canada (M.C.); Department of Anesthesia, University of Ottawa, Ottawa, Ontario, Canada (J.-Y.D.); Department of Surgery, Division of Cardiac and Vascular Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada (S.E.F.); Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada (B.K.); Department of Anesthesia, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada (C.L.); Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada (A.L.); Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada (J.-F.L.); Departments of Anesthesia and Critical Care, Keenan Research Center in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (C.D.M.); Department of Surgery, Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada (F.D.R.); Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada (C.S.).

Correspondence to Keyvan Karkouti, MD, Department of Anesthesia and Health Policy, Management, and Evaluation, Toronto General Hospital, University of Toronto, 200 Elizabeth St, EN 3-402, Toronto, Ontario, Canada M5G 2C4. E-mail keyvan.karkouti{at}uhn.on.ca

Received April 16, 2008; accepted November 13, 2008.

Background— Acute kidney injury (AKI) after cardiac surgery is a major health issue. Lacking effective therapies, risk factor modification may offer a means of preventing this complication. The objective of the present study was to identify and determine the prognostic importance of such risk factors.

Methods and Results— Data from a multicenter cohort of 3500 adult patients who underwent cardiac surgery at 7 hospitals during 2004 were analyzed (using multivariable logistic regression modeling) to determine the independent relationships between 3 thresholds of AKI (>25%, >50%, and >75% decrease in estimated glomerular filtration rate within 1 week of surgery or need for postoperative dialysis) with death rates, as well as to identify modifiable risk factors for AKI. The 3 thresholds of AKI occurred in 24% (n=829), 7% (n=228), and 3% (n=119) of the cohort, respectively. All 3 thresholds were independently associated with a >4-fold increase in the odds of death and could be predicted with several perioperative variables, including preoperative intra-aortic balloon pump use, urgent surgery, and prolonged cardiopulmonary bypass. In particular, 3 potentially modifiable variables were also independently and strongly associated with AKI. These were preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration.

Conclusions— AKI after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication.

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