COMPARATIVE STUDY OF INCIDENCE, RISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY IN POSTOPERATIVE PERIOD AFTER ON PUMP CABG VS ON PUMP CABG + VALVE REPLACEMENT SURGERY WITHOUT PREOPERATIVE MEDICAL RENAL DISEASE IN A TERTIARY CARE CENTRE
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Keywords
Acute Kidney Injury, Cardiopulmonary Bypass, Coronary Artery Bypass Grafting, Valve Replacement Surgery, Postoperative Complications.
Abstract
To compare the incidence, risk factors, and outcomes of acute kidney injury (AKI) in the postoperative period among patients undergoing on-pump coronary artery bypass grafting (CABG) alone versus those undergoing on-pump CABG with valve replacement surgery, in the absence of pre-existing medical renal disease.
Methods: This retrospective observational study included 100 patients—50 each undergoing on-pump CABG alone and on-pump CABG with valve replacement. Patients with prior renal dysfunction were excluded. Data were collected on demographic, preoperative, intraoperative, and postoperative variables. AKI was diagnosed based on KDIGO criteria. Statistical analysis was performed using Jamovi software. Group comparisons were made using appropriate statistical tests, and the predictive value of AKI for mortality was assessed using ROC curve analysis.
Results: The incidence of AKI was higher in the CABG + valve group (60%) than in the CABG-only group (50%), with more severe staging and greater dialysis requirement (34% vs 22%). The CABG + valve group had significantly higher preoperative creatinine levels and longer cross-clamp and CPB times. Intraoperative CPB flow rates and hematocrit were significantly lower, while fluid balance was more positive in CABG + valve group. Postoperatively, the CABG + valve group had greater use of inotropes, diuretics, and transfusions, along with higher serum creatinine levels, prolonged ventilation, ICU stay, and hospital stay. In-hospital mortality was also higher (30% vs 20%). ROC analysis confirmed AKI as a strong predictor of mortality (AUC 0.936 in CABG; 0.855 in CABG + valve group).
Conclusion: CABG with valve replacement is associated with a higher risk and severity of AKI and worse postoperative outcomes. Early identification and optimized perioperative care are critical to mitigate AKI-related complications.
References
2. Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 2006;1(1):19–32.
3. Mao H, Katz N, Ariyanon W, et al. Cardiac surgery-associated acute kidney injury. Cardiorenal Med. 2013;3(3):178–99.
4. O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: Current understanding and future directions. Crit Care. 2016;20(1):187.
5. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology. 2011;114(4):964–70.
6. Ristikankare A, Pöyhiä R, Kuitunen A, et al. Renal dysfunction after cardiac surgery with normothermic cardiopulmonary bypass: Incidence, risk factors, and effect on clinical outcome. Anesth Analg. 2010;110(6):1741–6.
7. Mehta RH, Grab JD, O’Brien SM, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation. 2006;114(21):2208–16.
8. Benedetto U, Luciani R, Goracci M, et al. Minimally invasive mitral valve surgery implies a lower risk of postoperative acute kidney injury. Ann Thorac Surg. 2011;92(4):1387–93.
9. Hobson CE, Yavas S, Segal MS, et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation. 2009;119(18):2444–53.
10. Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: A prospective cohort study. J Am Soc Nephrol. 2004;15(6):1597–605.
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Dr Suman Kr Chatterjee
MCh(CVTS), DrNB(CVTS), Assistant professor, department of CTVS, RG Kar Medical College & Hospital, Kolkata, Email: drsumankrc@gmail.com
Dr Dipankar Chowdhury
MS(General Surgery), MCh(CTVS) Trainee, RG Kar Medical College & Hospital, Kolkata, Email: dipankarctvs@gmail.com
