Association Between Changes in Preoperative Serum Creatinine and Acute Kidney Injury After Cardiac Surgery: A Retrospective Cohort Study.

IF 2.3 4区医学 Q2 PERIPHERAL VASCULAR DISEASE Kidney & blood pressure research Pub Date : 2024-10-18 DOI:10.1159/000541643

Bo Jiang, Yi Hao, Haiping Yang, Meiping Wang, Ran Lou, Yibing Weng, Genshen Zhen, Li Jiang

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Abstract

Introduction: Limited information exists regarding the impact of preoperative serum creatinine changes on cardiac surgery-associated acute kidney injury (CSA-AKI). This study aimed to investigate the development of AKI in patients with a baseline estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m2 who present with an elevation in preoperative serum creatinine.

Methods: This retrospective cohort study assessed patients who underwent open-heart surgery. Preoperative serum creatinine change was calculated as the ratio of the maximum preoperative serum creatinine value to the baseline creatinine (MCR). Patients were categorized into three groups based on MCR: non-elevation (≤1.0), mild elevation (1.0 to 1.5), and pronounced elevation (≥1.5). Multivariable logistic regression was used to estimate the risk of AKI, severe AKI, and non-recovery from AKI.

Results: There were significant increases in the odds of AKI (adjusted odds ratio [OR], 1.42; 95% confidence interval [CI], 1.29-1.57; per 0.1 increase in MCR), severe AKI (adjusted OR, 1.28; 95% CI, 1.15-1.41), and AKI non-recovery (adjusted OR, 1.29; 95% CI, 1.16-1.43). Pronounced elevation in preoperative serum creatinine was associated with a higher risk of AKI (adjusted OR, 15.45; 95% CI, 6.63-36.00), severe AKI (adjusted OR, 3.62; 95% CI, 1.20-10.87), and AKI non-recovery (adjusted OR, 4.74; 95% CI, 1.63-13.89) than non-elevation. Mild elevation in preoperative serum creatinine was also significantly associated with AKI (adjusted OR, 3.76; 95% CI, 1.92-7.37).

Conclusions: Elevation in preoperative serum creatinine from baseline was associated with an increased risk of AKI; even mild elevation significantly increased the risk of AKI.

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术前血清肌酐变化与心脏手术后急性肾损伤之间的关系：回顾性队列研究

导言：关于术前血清肌酐变化对心脏手术相关急性肾损伤（CSA-AKI）影响的信息十分有限。本研究旨在调查基线估计肾小球滤过率（eGFR）≥60 mL/min/1.73 m2 且术前血清肌酐升高的患者发生 AKI 的情况：这项回顾性队列研究评估了接受开胸手术的患者。术前血清肌酐变化按术前血清肌酐最大值与基线肌酐之比（MCR）计算。根据 MCR 将患者分为三组：未升高（≤1.0）、轻度升高（1.0 至 1.5）和明显升高（≥1.5）。多变量逻辑回归用于估算发生 AKI、严重 AKI 和 AKI 未恢复的风险：结果：发生 AKI（调整后的几率比 [OR]，1.42；95% 置信区间 [CI]，1.29-1.57；MCR 每增加 0.1）、严重 AKI（调整后的几率比 [OR]，1.28；95% 置信区间 [CI]，1.15-1.41）和 AKI 未恢复（调整后的几率比 [OR]，1.29；95% 置信区间 [CI]，1.16-1.43）的几率明显增加。与未升高的血清肌酐相比，术前血清肌酐明显升高与更高的 AKI（调整 OR，15.45；95% CI，6.63-36.00）、严重 AKI（调整 OR，3.62；95% CI，1.20-10.87）和 AKI 未恢复（调整 OR，4.74；95% CI，1.63-13.89）风险相关。术前血清肌酐轻度升高也与 AKI 显著相关（调整 OR，3.76；95% CI，1.92-7.37）：结论：术前血清肌酐从基线升高与发生 AKI 的风险增加有关；即使是轻度升高也会显著增加发生 AKI 的风险。

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来源期刊

Kidney & blood pressure research 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal comprises both clinical and basic studies at the interface of nephrology, hypertension and cardiovascular research. The topics to be covered include the structural organization and biochemistry of the normal and diseased kidney, the molecular biology of transporters, the physiology and pathophysiology of glomerular filtration and tubular transport, endothelial and vascular smooth muscle cell function and blood pressure control, as well as water, electrolyte and mineral metabolism. Also discussed are the (patho)physiology and (patho) biochemistry of renal hormones, the molecular biology, genetics and clinical course of renal disease and hypertension, the renal elimination, action and clinical use of drugs, as well as dialysis and transplantation. Featuring peer-reviewed original papers, editorials translating basic science into patient-oriented research and disease, in depth reviews, and regular special topic sections, ''Kidney & Blood Pressure Research'' is an important source of information for researchers in nephrology and cardiovascular medicine.