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.