Abstract 11368: Pre-operative Endothelin Levels Predict Post-operative Acute Kidney Injury in Cardiac Surgery
Introduction: Acute kidney injury (AKI) occurs in up to 40% of patients undergoing cardiac surgery and is associated with substantial morbidity and mortality, prolonged hospitalizations, and increased costs. AKI is clinically characterized by by a rapid reduction in kidney function resulting in a failure to maintain fluid, electrolyte and acid-base homoeostasis. Thus, there is a critical need to identify patients at increased risk for developing AKI when undergoing cardiac surgery. Endothelin is a locally produced vasoactive and natriuretic peptide with pro-inflammatory and pro-fibrotic properties that serves an important role in the regulation of renal hemodynamics and hemofiltration.
Hypothesis: In this study, we hypothesize that endothelin will predict post-operative AKI in patients undergoing cardiac surgery.
Methods: 105 patients undergoing cardiac surgery (either coronary bypass surgery and/or valve surgery) were recruited from the Veterans Affairs San Diego Health Care System and their plasma samples pre-operatively and at 2, 6, 12, 24, and 48 hours post-operatively were collected. A post-hoc analysis was then performed to determine the ability of pre-operative endothelin levels to predict post-operative AKI.
Results: Of 105 patients, 18 patients (17%) developed AKI post-operatively. Endothelin levels were elevated at baseline in patients who had a RIFLE score of at least 1, which is indicative of baseline renal injury. Preoperative endothelin was elevated in patients with post-operative AKI vs. no AKI (4.03 pg/mL [3.43-5.49] vs. 3.14 pg/mL [2.56-4.10], p=0.003). Interestingly, it was also determined that endothelin was superior to baseline creatinine in predicting AKI. Preoperative endothelin was predictive of post-operative AKI (AUC=0.721 (0.611-0.830), p=0.003) while there was no significant association between preoperative creatinine and post-operative AKI; p=0.953 (95% CI = 0.320-0.689).
Conclusions: Elevation of pre-operative endothelin levels predicts post-operative AKI in patients undergoing cardiac surgery. Future studies are needed to understand mechanisms by which elevations in endothelin levels can predict future renal injury.
Author Disclosures: R. Ghashghaei: None. N. Wetterson: None. J. Coletta: None. E. Golts: None. M. Patel: None. E. Lee: None. P. Clopton: None. R. Mehta: None. A.S. Maisel: None. P. Taub: None.
- © 2016 by American Heart Association, Inc.