Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis

Journal of Cardiothoracic Surgery

Michael Hilker¹  Christof Schmid¹  Bernhard Floerchinger¹  Daniele Camboni¹  Claudius Diez¹  Simon Schopka¹ 

[1] Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 57, 93057 Regensburg, Germany

关键词: Acute kidney injury;    Coronary artery bypass grafting;    Cardiopulmonary bypass;   

Others  :  811908
DOI  :  10.1186/1749-8090-9-20

 received in 2013-04-03, accepted in 2013-11-25,  发布年份 2014

【 摘 要 】

Background

Postoperative Acute Kidney Injury (AKI) after coronary artery bypass grafting (CABG) is a common complication associated with significant morbidity and mortality. Cardiopulmonary bypass (CPB) is accepted to contribute to the occurrence of AKI and is of particular importance as it can be avoided by using the off-pump technique. However the renoprotective properties of off-pump (CABG) are controversial. This analysis evaluates the impact of cardiopulmonary bypass on renal function.

Methods

A matched-pair analysis of 1428 patients undergoing coronary artery bypass grafting was conducted. The patients were stratified according to their preoperative renal function and to risk factors for postoperative AKI. The development of the glomerular filtration rate (GFR) from before surgery until hospital discharge was analyzed. Incidence of AKI were analyzed. Furthermore the impact of CPB duration on postoperative GFR was assessed.

Results

The occurrence of AKI increases the risk of thirty-day mortality (odds ratio of 4.3). The postoperative GFR decreases significantly after coronary artery bypass grafting but does not differ between onpump and offpump CABG (60.2 ± 24.5 vs 60.7 ± 24.8; p = 0.54). No difference regarding the incidence (26.6% vs 25%) and severity of AKI between cardiopulmonary bypass and the off-pump technique could be found. Duration of cardiopulmonary bypass does not correlate with the decline in postoperative glomerular filtration rate (Pearson Product Moment Correlation; p > 0.050).

Conclusion

Neither the mere use nor duration of cardiopulmonary bypass proofed to be a risk factor for developing postoperative AKI in CABG patients with a comparable preoperative risk profile for postoperative renal dysfunction. Furthermore, the severity of postoperative AKI is not affected by the use of cardiopulmonary bypass.

【 授权许可】

   
2014 Schopka et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Loef BG, Epema AH, Smilde TD, Henning RH, Ebels T, Navis G, Stegemann C: Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 2005, 16:195-200.
• [2]Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M: Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004, 15:1597-1605.
• [3]Tolpin D, Collard C, Lee V, Virani S, Allison P, Elayda A, et al.: Subclinical changes in serum creatinine and mortality after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2012, 143:682-688.
• [4]Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD: On-pump versus off- pump coronary revascularisation: evaluation of renal function. Ann Thorac Surg 1999, 68:493-498.
• [5]Gamoso MG, Phillips-Bute B, Landolfo KP, Newman MF, Stafford-Smith M: Off-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction. Anaesth Analg 2000, 91:1080-1084.
• [6]Hilker M, Arlt M, Keyser A, Schopka S, Klose A, Diez C, Schmid C: Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational analysis. J Cardiothorac Surg 2010, 25:5-14.
• [7]Puehler T, Haneya A, Philipp A, Wiebe K, Keyser A, Rupprecht L, Hirt S, Kobuch R, Diez C, Hilker M, Schmid C: Minimal extracorporeal circulation: an alternative for on- pump and off-pump coronary revascularization. Ann Thorac Surg 2009, 87:766-772.
• [8]Mehta RL, Kellum JA, Shah SV, et al.: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007, 11:R31. BioMed Central Full Text
• [9]Levey AS, Coresh J, Greene T, et al.: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006, 145:247-254.
• [10]Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT: Renal dysfunction after myocardial revascularization: Risk factors, adverse outcomes and hospital resource utilization. Ann Intern Med 1998, 128:194-203. 10
• [11]Abel RM, Buckley MJ, Austen WG, Barnett GO, Beck CH Jr, Fischer JE: Etiology, incidence and prognosis of renal failure following cardiac surgeries. Results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg 1976, 71:323-333.
• [12]Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J: Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998, 104:343-348.
• [13]Massoudy P, Wagner S, Thielmann M, Herold U, Kottenberg-Assenmacher E, Marggraf G, Kribben A, Philipp T, Jakob H, Herget-Rosenthal S: Coronary artery bypass surgery and acute kidney injury—impact of the off-pump technique. Nephrol Dial Transplant 2008, 23:2853-2860.
• [14]Chertow GM, Lazarus JM, Christiansen CL, et al.: Preoperative renal risk stratification. Circulation 1997, 95:878-884.
• [15]Conlon PJ, Stafford-Smith M, White WD, et al.: Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999, 14:1158-1162.
• [16]Slogoff S, Reul GJ, Keats AS, Curry GR, Crum ME, Elmquist BA, Giesecke NM, Jistel JR, Rogers LK, Soderberg JD, et al.: Role of perfusion pressure and flow in major organ dysfunction after cardiopulmonary bypass. Ann Thorac Surg 1990, 50:911-918.
• [17]Diez C, Haneya A, Brunger F, Philipp A, Hirt S, Ruppecht L, Kobuch R, Keyser A, Hilker M, Puehler T, Schmid C: Minimized extracorporeal circulation cannot prevent acute kidney injury but attenuates early renal dysfunction after coronary bypass grafting. ASAIO 2009, 55:602-607.
• [18]Kolh P, Wijns W, Danchin N, Di Mario C, Falk V, Folliguet T, Garg S, Huber K, James S, Knuuti J, Lopez- Sendon J, Marco J, Menicanti L, Ostojic M, Piepoli M, Pirlet C, Pomar J, Reifart N, Ribichini F, Schalij M, Sergeant P, Serruys P, Silber S, Sousa Uva M, Taggart D, The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI), Authors/Task Force Members: Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2010, 38:1-52.
• [19]Loef BG, Epema AH, Navis G, Ebels T, van Oeveren W, Henning RH: Off-pump coronary revascularization attenuates transient renal damage compared with on- pump coronary revascularization. Chest 2002, 121:1190-1194.
• [20]Schwann NM, Horrow JC, Strong MD, Chamchad D, Guerraty A, Wechsler AS: Does off-pump coronary artery bypass reduce the incidence of clinically evident renal dysfunction after multivessel myocardial revascularization? Anesth Analg 2004, 99:959-964.
• [21]Beauford RB, Saunders CR, Niemeier LA, Lunceford TA, Karanam R, Prendergast T, Shah S, Burns P, Sardari F, Goldstein DJ: Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency? Heart Surg Forum 2004, 7:E141-E146.
• [22]Stallwood MI, Grayson AD, Mills K, Scawn ND: Acute renal failure in coronary artery bypass surgery: Independent effect of cardiopulmonary bypass. Ann Thorac Surg 2004, 77:968-972.
• [23]Tuttle KR, Worrall NK, Dahlstrom LR, Nandagopal R, Kausz AT, Davis CL: Predictors of ARF after cardiac surgical procedures. Am J Kidney Dis 2003, 41:76-83.
• [24]Fischer UM, Weissenberger WK, Warters RD, Geissler HJ, Allen SJ, Mehlhorn U: Impact of cardiopulmonary bypass management on postcardiac surgery renal function. Perfusion 2002, 17:401-406.