Is ultrafiltration volume a predictor of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass?

Abstract

Introduction

Intraoperative ultrafiltration (UF) is a procedure used during cardiopulmonary bypass (CPB) to reduce haemodilution and prevent excessive blood transfusion. However, the effect of UF volume on acute kidney injury (AKI) is not well established, and the results are conflicting. Additionally, there are no set indications for applying UF during CPB.

Methods

This retrospective study analysed 641 patients who underwent coronary artery bypass graft (CABG) surgery with CPB. Perioperative parameters were extracted from the patients’ records, and the UF volume was recorded. Acute Kidney Injury Network classification was used to define AKI. Univariable and multivariable logistic regression models were used to predict AKI while controlling for confounding factors.

Results

The study enrolled patients with a mean age of 58.8 ± 11.1 years, 39.2% of whom were female. AKI occurred in 22.5% of patients, with 16.1% (103) experiencing stage I and 6.4% (41) experiencing stage II. The results showed a significant association between UF volume and the risk of developing AKI, with higher UF volumes associated with a higher risk of AKI. In the multivariable analysis, the other predictors of AKI included age, lowest mean arterial pressure (MAP), and red blood cell (RBC) transfusion during CPB.

Conclusion

The predictors of postoperative AKI in coronary CABG patients were the volume of UF, age, MAP, and blood transfusion during CPB.

Keywords

acute kidney injury ultrafiltration haemofiltration cardiopulmonary bypass

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References

Dasta

Kane-Gill

Durtschi

, et al. Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. J ERAndt 2008; 23(6): 1970–1974.

Matata

Scawn

Morgan

, et al. A single-center randomized trial of intraoperative zero-balanced ultrafiltration during cardiopulmonary bypass for patients with impaired kidney function undergoing cardiac surgery. J JCVA 2015; 29(5): 1236–1247.

Cheng

Wright

. Cardiac surgery acute kidney injury: controversy in renal support. In: Difficult decisions in cardiothoracic critical care surgery. 1th ed. Switzerland: Springer, 2019, pp. 511–523.

O'Neal

Shaw

Billings

. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care J 2016; 20(1): 187.

Ranucci

Aloisio

Carboni

, et al. Acute kidney injury and hemodilution during cardiopulmonary bypass: a changing scenario. Jpn Ann Thorac Surg 2015; 100(1): 95–100.

Song

Kim

Kwak

, et al. Urine output during cardiopulmonary bypass predicts acute kidney injury after cardiac surgery: a single-center retrospective analysis. J Med 2016; 95(22): e3757.

Chew

. Does modified ultrafiltration reduce the systemic inflammatory response to cardiac surgery with cardiopulmonary bypass? Perfusion J 2004; 19(Suppl 1): 57–60.

Karadem

Abud

Kunt

. The effect of the hemofiltration-body surface area on the mortality and morbidity during cardiopulmonary bypass. WJCS J 2018; 8(8): 140–149.

Paugh

Dickinson

Martin

, et al. Impact of ultrafiltration on kidney injury after cardiac surgery: the Michigan experience. Jpn Ann Thorac Surg 2015; 100(5): 1683–1688.

10.

Boyle

Maurer

Sobotka

. Myocellular and interstitial edema and circulating volume expansion as a cause of morbidity and mortality in heart failure. JCF J 2007; 13(2): 133–136.

11.

Kuntz

Holt

Turner

, et al. Effects of conventional ultrafiltration on renal performance during adult cardiopulmonary bypass procedures. J Extra Corpor Technol 2006; 38(2): 144–153.

12.

Cockcroft

Gault

. Prediction of creatinine clearance from serum creatinine. Nephron J 1976; 16(1): 31–41.

13.

Mehta

Kellum

Shah

, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. J Crit Care 2007; 11(2): R31.

14.

Fehrman-Ekholm

Skeppholm

. Renal function in the elderly (>70 years old) measured by means of Iohexol clearance, serum creatinine, serum urea and estimated clearance. Scand J Urol J 2004; 38(1): 73–77.

15.

Manning

Linder

, et al. Conventional ultrafiltration during elective cardiac surgery and postoperative acute kidney injury. J JCVA 2021; 35(5): 1310–1318.

16.

Boodhwani

Williams

Babaev

, et al. Ultrafiltration reduces blood transfusions following cardiac surgery: a meta-analysis. J EJCTS 2006; 30(6): 892–897.

17.

Ganz

Rawn

, et al. Clinical and economic outcomes associated with blood transfusions among elderly Americans following coronary artery bypass graft surgery requiring cardiopulmonary bypass. J Blood transfusion = Trasfusione del sangue 2014; 12(Suppl 1): 90–99.

18.

Karkouti

Wijeysundera

Yau

, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. J Circulation 2009; 119(4): 495–502.

19.

Rabie Soliman

Belghith

Abdelmageed

. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery. Ann Card Anaesth J 2016; 19(1): 45–51.

20.

Ferraris

Saha

, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists clinical practice guideline. Jpn Ann Thorac Surg 2007; 83(5 Suppl): 27–86.

21.

Mongero

Tesdahl

Stammers

, et al. The influence of ultrafiltration on red blood cell transfusion during cardiopulmonary bypass. J Perfusion 2019; 34(4): 303–309.

22.

Lannemyr

Bragadottir

Krumbholz

, et al. Effects of cardiopulmonary bypass on renal perfusion, filtration, and oxygenation in patients undergoing cardiac surgery. J Anesthesiol 2017; 126(2): 205–213.

23.

Abu-Omar

Ratnatunga

. Cardiopulmonary bypass and renal injury. Perfusion J 2006; 21(4): 209–213.

24.

Gumbert

Kork

Jackson

, et al. Perioperative acute kidney injury. J Anesthesiology 2020; 132(1): 180–204.

25.

Mongero

Stammers

Tesdahl

, et al. The effect of ultrafiltration on end-cardiopulmonary bypass hematocrit during cardiac surgery. J Perfusion 2018; 33(5): 367–374.

26.

Zhu

, et al. Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review. Eur J Med Res 2023; 28(1): 45.

27.

Udzik

Waszczyk

Safranow

, et al. Assessment and prognosis in CSA-AKI using novel Kidney injury biomarkers: a prospective observational study. J Biology (Basel) 2021; 10(9): 823.

28.

Iguchi

Lankadeva

Evans

, et al. Renal cortical perfusion, measured by superb microvascular imaging, during infusion of norepinephrine in experimental cardiopulmonary bypass. J AJRCCM 2019; 199(12): 1564–1565.

29.

Qvisth

Hagstrom-Toft

Enoksson

, et al. Catecholamine regulation of local lactate production in vivo in skeletal muscle and adipose tissue: role of β-adrenoreceptor subtypes. J Clin Endocrinol Metab 2008; 93(1): 240–246.

30.

Bellomo

Di Giantomasso

. Noradrenaline and the kidney: friends or foes? Crit Care J 2001; 5(6): 294–298.

31.

Burke

R Pabbidi

Farley

, et al. Molecular mechanisms of renal blood flow autoregulation. J Curr Vasc Pharmacol 2014; 12(6): 845–858.

32.

De La Hoz

Rangasamy

Bastos

, et al. Intraoperative hypotension and acute kidney injury, stroke, and mortality during and outside cardiopulmonary bypass: a retrospective observational cohort study. J Anesthesiol 2022; 136(6): 927–939.

33.

Engelman

Ben Ali

Williams

, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. J JAMA surgery 2019; 154(8): 755–766.

34.

Johnston

Thiele

Hawkins

, et al. Goal-directed resuscitation following cardiac surgery reduces acute kidney injury: a quality initiative pre-post analysis. J Thorac Cardiovasc Surg 2020; 159(5): 1868–1877.

35.

Husain-Syed

Quattrone

Ferrari

, et al. Clinical and operative determinants of acute kidney injury after cardiac surgery. J Cardiorenal medicine 2020; 10(5): 340–352.

36.

Khademi

Mehr

Janati

, et al. Association of urine output during cardiopulmonary bypass and postoperative acute kidney injury in patients undergoing coronary artery bypass graft. J Perfusion 2023; 38(3): 567–573.

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