Thorac Cardiovasc Surg 2022; 70(S 01): S1-S61
DOI: 10.1055/s-0042-1742881
Oral and Short Presentations
Monday, February 21
Risk Management in Coronary Artery Disease

Acute Kidney Injury after Coronary Artery Bypass Grafting: A Risk Factor Analysis

L. Bax
1   Department of cardiovascular surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland
,
T. J. Demal
1   Department of cardiovascular surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland
,
F. Onorati
2   Department of anesthesiology and surgery, University of Verona, Verona, Italy
,
F. Nicolini
3   University of Parma, Parma, Italy
,
A. Perrotti
4   Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
,
M. De Feo
5   Dipartimento di Scienze Cardio-Toraciche e Respiratorie, Second University of Naples, Napoli, Italy
,
G. Santarpino
6   Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
,
G. Mariscalco
7   University of Leicester, Leicester, United Kingdom
,
H. Reichenspurner
1   Department of cardiovascular surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland
,
F. Biancari
8   University of Turku, Turku, Finland
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    Background: Postoperative acute kidney injury (AKI) is known to be a driving factor for prolonged hospital stay and mortality. Thus, identification of risk factors that can predict the risk of postoperative occurrence of AKI is of utmost importance.

    Method: From 01/2015 to 05/2017, a total of 7,222 consecutive patients without end stage renal disease who underwent isolated CABG were included in the multicenter E-CABG registry. To identify risk factors for the occurrence of AKI stage 2 or 3, we used multivariate logistic regression analysis. The impact of AKI on mortality was evaluated using cox regression analysis.

    Results: Mean age was 67.4 ± 9.4 years with 83.7% male patients. AKI stage 2 or 3 occurred in 366 patients. Overall 30-day and 6-month mortality was 1.6% and 3.0%, respectively.

    Statistically significant independent risk factors for development of AKI are shown in[Table 1].

    Table 1

    Identified risk factors for AKI using logistic regression analysis

    OR

    CI

    p-Value

    BMI (>30)

    1.581

    1.246–1.2.006

    <0.001

    Peripheral artery disease

    1.434

    1.127–1.824

    0.003

    Preoperative anemia

    1.515

    1.190–1.929

    <0.001

    OPCAB procedure

    1,361

    1.094–1.766

    0.020

    Prolonged inotropes

    2.066

    1.626–2.625

    <0.001

    Postoperative ECMO/IABP

    2.987

    2.034 -4.388

    <0.001

    Resternotomy

    3.024

    2.051 -4.460

    <0.001

    Age (>75 years), gender, PCI within 7 days preoperatively, presence of diabetes, hypertension, elevated creatinine level (>1.1 mg/dL), STEMI, out of hospital cardiac arrest, preoperative hemodynamic instability and LVEF <30% were included into the regression model, but did not reach statistical significance. Univariate Cox regression analysis revealed hazard ratios for 30-day and 6-month mortality in patients with development of AKI stage 2 or 3 of 22.1 (CI: 15.3–31.9) and 15.0 (CI: 11.2–20.1), respectively.

    Conclusion: Especially patients with high BMI, preoperative anemia and postoperative complications are at high risk of AKI. Considering the strong association of postprocedural AKI with mortality reflected by the high HR in cox regression analysis, surgical as well as interventional treatment options should be weighed against each other in the interdisciplinary heart team in patients with risk factors for AKI.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    03 February 2022

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