title: Time from cardiac catheterization to cardiac surgery: a risk factor for acute kidney injury?.
abstract: OBJECTIVE
  Acute kidney injury can occur after cardiac catheterization and cardiac surgery. The negative effects of the contrast media and cardiopulmonary bypass on renal function may be additive when performed in close succession. The results in the literature are, however, conflicting.
  
  
  METHODS
  Preoperative, operative, perioperative and postoperative variables of 573 consecutive adult patients who underwent cardiac surgery on cardiopulmonary bypass were collected prospectively. Acute kidney injury (AKI) was defined according to the Acute Kidney Injury Network criteria based on changes in serum creatinine level within 48 h of surgery.
  
  
  RESULTS
  Acute kidney injury was detected in 233 patients (41%). In a multivariate analysis, older age (P = 0.01), longer cardiopulmonary bypass time (P = 0.003), lower preoperative haematocrit level (P = 0.02) and higher body mass index (P = 0.001) were found to be independently associated with development of acute kidney injury. Analysis of the time from cardiac catheterization to surgery by logistic regression modelling did not show any significant change in the risk of acute kidney injury. Risk related to time from catheterization to surgery was not increased even in the patients with elevated preprocedural creatinine levels (>106 μmol l(-1); P = 0.23), left ventricular dysfunction (ejection fraction <40%; P = 0.19) and older age (≥70 years; P = 0.86).
  
  
  CONCLUSIONS
  The time from cardiac catheterization to cardiac surgery is not a risk factor for the development of postoperative acute kidney injury even in patients with other risk factors. Surgical intervention should not be delayed in emergency or urgent cases. The optimization of renal function seems to be the correct strategy in clinically stable patients with risk factors for acute kidney injury.
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey berkozkaynak@gmail.com.
authors.forename: Berk
authors.initials: B
authors.lastname: Ozkaynak
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Nihan
authors.initials: N
authors.lastname: Kayalar
authors.affiliation: Department of Anesthesiology, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Funda
authors.initials: F
authors.lastname: Gümüş
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Cihan
authors.initials: C
authors.lastname: Yücel
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Mert
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Kamil
authors.initials: K
authors.lastname: Boyacıoğlu
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Erentuğ
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000097:blood; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Cardiac catheterization; Complications; Kidney; Renal failure; Surgery