title: Preoperative Low Serum Bicarbonate Levels Predict Acute Kidney Injury After Cardiac Surgery.
abstract: Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Although lower than normal serum bicarbonate levels are known to be associated with consecutive renal function deterioration in patients with chronic kidney injury, it is not well-known whether preoperative low serum bicarbonate levels are associated with the development of AKI in patients who undergo cardiac surgery. Therefore, the clinical implication of preoperative serum bicarbonate levels on AKI occurrence after cardiac surgery was investigated. Patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from January 2013 to December 2014 were enrolled. The patients were divided into 3 groups based on preoperative serum bicarbonate levels, which represented group 1 (below normal levels) <23 mEq/L; group 2 (normal levels) 23 to 24 mEq/L; and group 3 (elevated levels) >24 mEq/L. The primary outcome was the predicated incidence of AKI 48 hours after cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Among 875 patients, 228 (26.1%) developed AKI within 48 hours after cardiac surgery. The incidence of AKI was higher in group 1 (40.9%) than in group 2 (26.5%) and group 3 (19.5%) (P < 0.001). In addition, the duration of postoperative stay in a hospital intensive care unit (ICU) was longer for AKI patients and for those in the low-preoperative-serum-bicarbonate-level groups. A multivariate logistic regression analysis showed that low preoperative serum bicarbonate levels were significantly associated with AKI even after adjustment for age, sex, hypertension, diabetes mellitus, operation type, preoperative hemoglobin, and estimated glomerular filtration rate. In conclusion, low serum bicarbonate levels were associated with higher incidence of AKI and prolonged ICU stay. Further studies are needed to clarify whether strict correction of bicarbonate levels close to normal limits may have a protective role in preventing further AKI development.
authors.affiliation: From the Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, South Korea.
authors.forename: Su-Young
authors.initials: SY
authors.lastname: Jung
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kwon
authors.forename: Hyung Woo
authors.initials: HW
authors.lastname: Kim
authors.forename: Geun Woo
authors.initials: GW
authors.lastname: Ryu
authors.forename: Sul A
authors.initials: SA
authors.lastname: Lee
authors.forename: Seohyun
authors.initials: S
authors.lastname: Park
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Jhee
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D001639:Bicarbonates