title: Chronic kidney disease as major determinant of the renal risk related to on-pump cardiac surgery: a single-center cohort study.
abstract: BACKGROUND
  Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication and is associated with the poorest outcomes. Therefore, early prediction of CSA-AKI remains a major issue. Severity scores such as the STS score could estimate the risk of AKI preoperatively. The main objective of this study was to evaluate the risk factors of on-pump CSA-AKI and to assess the performance of the STS score in order to predict CSA-AKI.
  
  
  METHODS
  We identified 252 patients with on-pump cardiac surgery, and the STS score was defined retrospectively.
  
  
  RESULTS
  AKI occurred in 14.6% (n = 37/252) of patients and renal replacement therapy was required in 21.6% of AKI (n = 8/37). CSA-AKI was associated with 35.1% in-hospital mortality (vs. 1.4%) and nearly doubled length of stay (14.5 vs. 8.0 d). The risk of CSA-AKI was mainly determined by preoperative morbidities such as chronic kidney disease, peripheral vascular disease, and severe congestive heart failure. Long cardio-pulmonary bypass time was also a determinant. CSA-AKI + patients exhibited higher STS renal risk (5.6% vs. 2.0%; p < 0.0001), resulting in a good discrimination between AKI + and AKI - patients (area under curve [AUC] 0.80). Interestingly, a basal renal function ≤55 ml/min/1.73m2was as good as the STS score to predict CSA-AKI (AUC 0.75; P 0.26).
  
  
  CONCLUSIONS
  On-pump CSA-AKI was observed in nearly 15% of cases and was associated with poorer outcomes. Interestingly, the risk of CSA-AKI could be estimated preoperatively, thanks to the basal renal function, which exhibited an equal performance to the STS score.
authors.affiliation: a Department of Nephrology , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Hougardy
authors.affiliation: a Department of Nephrology , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
authors.forename: Perrine
authors.initials: P
authors.lastname: Revercez
authors.affiliation: a Department of Nephrology , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
authors.forename: Aline
authors.initials: A
authors.lastname: Pourcelet
authors.affiliation: b Department of Cardiac Surgery , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
authors.forename: Bachar El
authors.initials: BE
authors.lastname: Oumeiri
authors.affiliation: a Department of Nephrology , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
authors.forename: Judith
authors.initials: J
authors.lastname: Racapé
authors.affiliation: a Department of Nephrology , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
authors.forename: Alain
authors.initials: A
authors.lastname: Le Moine
authors.affiliation: b Department of Cardiac Surgery , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vanden Eynden
authors.affiliation: c Department of Intensive Care , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate
keywords: Acute kidney injury; STS calculator; cardiac surgery; cardiopulmonary bypass