Results
28.68% in the adult group and 20.07% in the pediatric group developed CSA-AKI. Adult risk factors included age group of 60-69 years, cardiopulmonary bypass (CPB), number of grafts and hypertension. In the pediatric group, CPB, aortic cross-clamping (ACX) and the lower preoperative SCr are the main risk factors
ConclusionConventional conservative management and preoperative Identification of predictor risk factors are essential for prevention of CSA-AKI which constitute the main strategy for optimal management.
Introduction
Acute kidney injury (AKI) is a rapid deterioration of glomerular filtration rate (GFR) that is associated with significant impairment of renal function. CSA-AKI is reported in up to 30% and considered an independent risk factor for increased morbidity and mortality causing dialysis in up to 4%1-4. Slight increase of (0.3-0.5 mg/dL) in SCr is significantly correlated to an increase in 30-days mortality5. CSA-AKI is the second cause of AKI in intensive care units (ICU) preceded by sepsis increasing the death by fourfold reaching up to 8%6-7. Mortality associated with renal replacement therapy (RRT) reaches up to 63%8. It is known that hypertension, advanced age, hyperlipidemia, and peripheral vascular disease are nonmodifiable risk factors for AKI9. Uniquely among surgeries, cardiac surgery has some properties that increase the risk of AKI such as CPB, ACX, high rates, and volumes of exogenous blood product transfusion and high doses of vasopressors 10. Fortunately, many CSA-AKI risk factors can be modified. Identifying risk factors is one of the most important strategies to prevent or minimize CSA-AKI.
Methodology
This is an observational retrospective cohort study done at KAUH Jeddah, SA approved by KAUH ethical committee. 1265 patients underwent cardiac surgery between January 2016 and December 2020. CSA-AKI was defined for pediatric and adult groups by AKIN as an increase in SCr of ≥ 0.3 mg/dL above baseline that persisted for more than 48 hours postoperatively. Also, it classifies CSA-AKI into 3 stages11. (Table 1) The exclusion criteria were: baseline SCr ≥ 4 mg/dL or preexisting renal failure requiring dialysis, reoperation, death within 24 hours postoperatively, and operative mortality or missing data. 941 patients were included in the analysis using the statistical software SPSS , version 15.0. Mann-Whitney test was used in univariate analysis of continuous variables and the Person Chi-square test or Fisher’s exact test was used to analyze categorical variables.
(Table 1): Acute Kidney Injury Network (AKIN) criteria.