title: The prognostic value of using the duration of acute kidney injury in cardiac surgery: an example using two antifibrinolytics.
abstract: Previously, we reported that the addition of duration to the Acute Kidney Injury Network (AKIN) definition of acute kidney injury (AKI) is a marker for more severe kidney injury and predicts long-term mortality. We aimed to evaluate an example of the utility of adding AKI duration to the AKIN definition by comparing the historical use of aprotinin with Amicar. In a single-center observational study, we followed 4987 consecutive patients undergoing cardiac surgery between 2002 and 2007 for postsurgery AKI. Patients with a history of hemodialysis were excluded. Duration of AKI was calculated by the number of days AKI was present as defined by a > or = 0.3 (mg/dL) or a > or = 50% increase in serum creatinine from baseline or new onset of acute dialysis. Kaplan-Meier and Cox's proportional hazard modeling was conducted to evaluate 5-year mortality. Fifty-three percent of patients received Amicar (n = 2333) and 47% received high-dose aprotinin (n = 2093). Patients receiving aprotinin had evidence of more advanced disease and comorbidity and were more likely to develop AKI and have longer durations of AKI than Amicar (p < .001): 7.0 +/- 11.5 vs. 3.8 +/- 6.0 days (p < .001). Nearest-neighbor propensity matching demonstrated aprotinin had significantly worse 5-year mortality compared with Amicar (relative risk [RR] = 2.09, 95% confidence interval [CI] = 1.65-2.65). AKI duration added to the AKIN definition of AKI may provide the necessary sensitivity and specificity for evaluating renal outcomes in clinical trials.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Section of Cardiology Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. jbrown@dartmouth.edu
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kramer
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000473:pathology; D000368:Aged; D000933:Antifibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D003404:Creatinine