Published Online
on January 19, 2009

A more recent version of this article appeared on February 3, 2009

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Submitted on April 16, 2008
Accepted on November 13, 2008

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, and 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.).

^* To whom correspondence should be addressed. E-mail: keyvan.karkouti{at}uhn.on.ca.

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.

Key words: surgery • cardiopulmonary bypass • kidney • risk factors

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Circulation: Clinical Summaries
Circulation 2009 119: 487-488. [Extract] [Full Text]

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