Predictors of acute kidney injury after coronary artery surgery in Jordanians

Abstract

Background

Acute kidney injury after coronary artery bypass surgery is associated with increased morbidity and mortality. We investigated the predictors of acute kidney injury in a major hospital in Jordan.

Methods

A retrospective analysis was conducted of clinical, operative, and outcome data of 867 patients (mean age 59 ± 9.8 years) who underwent isolated coronary bypass surgery with cardiopulmonary bypass. Acute kidney injury postoperatively, defined as ≥100% increase in serum creatinine level, was the outcome variable. Retrospective clinical, laboratory, and demographic data, and medication use, were obtained from electronic medical records.

Results

Univariate analysis revealed that chronic obstructive pulmonary disease, recent myocardial infarction, emergency surgery, preoperative intraaortic balloon pump use, left atrial size >4 cm, grade 1 mitral regurgitation, pneumonia, intensive care unit stay, prolonged vasopressor support, and stroke or transient ischemic attack were significantly associated with postoperative renal failure. On multivariate logistic regression, emergency surgery (adjusted odds ratio = 2.17, p = 0.017), grade 1 mitral regurgitation (adjusted odds ratio = 2.05, p = 0.020), prolonged support (adjusted odds ratio = 3.16, p = 0.000), and stroke (adjusted odds ratio = 20.1, p = 0.004) were independent predictors of kidney injury following coronary bypass surgery.

Conclusion

Emergency coronary surgery, mitral regurgitation, prolonged inotropic support, and stroke or transient ischemic attack are independent predictors of acute kidney injury following coronary bypass surgery. Further studies involving patients with isolated coronary bypass surgery as well as valve and combined surgeries may be necessary to complete our understanding of this subject.