title: Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study.
abstract: Perioperative risk factors were identified for acute kidney injury (AKI) defined by the RIFLE criteria (RIFLE = risk, injury, failure, loss, end stage) after surgery on the thoracic aorta with cardiopulmonary bypass (CPB) in this case-control study. A retrospective review was completed for 702 patients who underwent surgery on the thoracic aorta with CPB. A total of 183 patients with AKI were matched 1:1 with patients without AKI by a propensity score. Matched variables included age, gender, body-mass index, preoperative creatinine levels, estimated glomerular filtration rate, a history of hypertension, diabetes mellitus, cerebrovascular accident, smoking history, or chronic obstructive pulmonary disease to exclude the influence of patient demographics, preoperative medical status, and baseline renal function. Multivariate logistic regression analysis was used to evaluate for independent risk factors in the matched sample of 366 patients. The incidence of AKI was 28.6% and 5.9% of patients from the entire sample required renal replacement therapy. AKI was associated with a prolonged postoperative hospital stay and a higher one-month and one-year mortality both in the entire and matched sample set. Independent risk factors for AKI were a left ventricular ejection fraction <55%, preoperative hemoglobin level <10 g/dL, albumin <4.0 g/dL, diagnosis of dissection, operation time >7 hours, deep hypothermic circulatory arrest (DHCA) time >30 min, pRBC transfusion >1000 mL, and FFP transfusion >500 mL. Although the incidence of poor glucose control (blood glucose >180 mg/dL) was higher in patients with AKI in matched sample, it was not an independent risk factor.AKI was still associated with a poor clinical outcome in the matched sample. Potentially modifiable risk factors included preoperative anemia and hypoalbuminemia. Efforts to minimize operation time and DHCA time along with transfusion amount may protect patients undergoing aortic surgery against AKI.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea (WHK, HSS); Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (MHP, HJK, H-YL, CSK, SML); and Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea (J-TS).
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Mi Hye
authors.initials: MH
authors.lastname: Park
authors.forename: Hyo-Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Hyun-Young
authors.initials: HY
authors.lastname: Lim
authors.forename: Haeng Seon
authors.initials: HS
authors.lastname: Shim
authors.forename: Ju-Tae
authors.initials: JT
authors.lastname: Sohn
authors.forename: Chung Su
authors.initials: CS
authors.lastname: Kim
authors.forename: Sangmin M
authors.initials: SM
authors.lastname: Lee
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D015987:Effect Modifier, Epidemiologic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D057216:Propensity Score; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality