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Volume-associated hemodynamic variables for prediction of cardiac surgery-associated acute kidney injury

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Abstract

Background

Delayed diagnosis of acute kidney injury (AKI) is common because the changes in renal function markers often lag injury. We aimed to find optimal non-invasive hemodynamic variables for the prediction of postoperative AKI and AKI renal replacement therapy (RRT).

Methods

The data were collected from 1,180 patients who underwent cardiac surgery in our hospital between March 2015 and Feb 2016. Postoperative central venous pressure (CVP), mean arterial pressure (MAP), heart rate, PaO2, and PaCO2 on ICU admission and daily fluid input and output (calculated as 24 h PFO) were monitored and compared between AKI vs. non-AKI and RRT vs non-RRT cases.

Results

The AKI and AKI-RRT incidences were 36.7% (n = 433) and 1.2% (n = 14). Low cardiac output syndromes (LCOSs) occurred significantly more in AKI and RRT than in non-AKI or non-RRT groups (13.2% vs. 3.9%, P < 0.01; 42.9% vs. 7.1%, P < 0.01). CVP on ICU admission was significantly higher in AKI and RRT than in non-AKI and non-RRT groups (11.5 vs. 9.0 mmHg, P < 0.01; 13.3 vs. 9.9 mmHg, P < 0.01). 24 h PFO in AKI and RRT cases were significantly higher than in non-AKI or non-RRT patients (1.6% vs. 0.9%, P < 0.01; 3.9% vs. 0.8%, P < 0.01). The areas under the ROC curves to predict postoperative AKI by CVP on ICU admission (> 11 mmHg) + LCOS + 24 h PFO (> 5%) and to predict AKI-RRT by CVP on ICU admission (> 13 mmHg) + LCOS + 24 h PFO (> 5%) were 0.763 and 0.886, respectively.

Conclusion

The volume-associated hemodynamic variables, including CVP on ICU admission, LCOS, and 24 h PFO after surgery could predict postoperative AKI and AKI-RRT.

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Acknowledgements

This work was supported by the Shanghai Key Laboratory of Kidney and Blood Purification (Grant number. 14DZ2260200); Shanghai Clinical Medical Center for Kidney Disease Project support by Shanghai Municipal Health Commission (Grant number. 2017ZZ01015); National Natural Science Foundation of China (Grant number. 81901939); Shanghai “science and technology innovation plan” popular science project (Grant number 19DZ2321400) and Xiamen Science and Technology Plan in 2018 (Grant number. 3502Z20184009).

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Author notes

  1. Jiarui Xu and Wuhua Jiang authors contributed equally to the article.

Authors and Affiliations

  1. Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China

    Jiarui Xu, Wuhua Jiang, Yang Li, Bo Shen, Ziyan Shen, Yimei Wang, Jiachang Hu, Yi Fang, Jie Teng, Xiaoqiang Ding & Jiawei Yu

  2. Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China

    Jiarui Xu, Wuhua Jiang, Yang Li, Bo Shen, Ziyan Shen, Yimei Wang, Jiachang Hu, Yi Fang, Jie Teng, Xiaoqiang Ding & Jiawei Yu

  3. Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China

    Jiarui Xu, Wuhua Jiang, Yang Li, Bo Shen, Ziyan Shen, Yimei Wang, Jiachang Hu, Yi Fang, Jie Teng, Xiaoqiang Ding & Jiawei Yu

  4. Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China

    Jiarui Xu, Wuhua Jiang, Yang Li, Bo Shen, Ziyan Shen, Yimei Wang, Jiachang Hu, Yi Fang, Jie Teng, Xiaoqiang Ding & Jiawei Yu

  5. Shanghai Hemodialysis Quality of Control Center, No. 180 Fenglin Road, Shanghai, 200032, China

    Yimei Wang, Yi Fang, Jie Teng, Xiaoqiang Ding & Jiawei Yu

  6. Department of Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China

    Zhe Luo

  7. Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China

    Chunsheng Wang

  8. Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, No. 668 Jinhu Road, Xiamen, 361015, China

    Jie Teng & Xiaoqiang Ding

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  1. Jiarui Xu
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Corresponding authors

Correspondence to Jie Teng, Xiaoqiang Ding or Jiawei Yu.

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The authors have declared that no conflict of interest exists.

Human participants and/or animals

The ethical committee of the Shanghai Zhongshan Hospital approved the study (No. B2017-039) and our study was performed in accordance with the Declaration of Helsinki regarding the ethical principles for medical research involving human subjects.

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Xu, J., Jiang, W., Li, Y. et al. Volume-associated hemodynamic variables for prediction of cardiac surgery-associated acute kidney injury. Clin Exp Nephrol 24, 798–805 (2020). https://doi.org/10.1007/s10157-020-01908-6

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