Analysis of Risk Factors for Death in Patients Undergoing Continuous Renal Replacement Therapy after On-pump Cardiovascular Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAOKe , YUHui ,  ZENGling

Department of Cardiovascular Surgery ICU, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

ZENGling, Email: yukung@126.com

Keywords：

Acute kidney injury; Cardiopulmonary bypass; Risk factors

DOI：

10.7507/1007-4848.20160230

Video：

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Objective To retrospectively evaluate the risk factors of mortality in postoperative acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT) after cardiopulmonary bypass (CPB). Methods We retrospectively analyzed the clinical data of 66 patients (38 males and 28 females with mean age of 59.11±12.62 years) underwent CRRT after cardiovascular surgery in our hospital between May 2009 and June 2014. The patients were divided into a survival group (18 patients) and a death group (48 patients) according to treatment outcome at discharge. Univariate analysis for risk factors of death was carried out for preoperative characteristics and lab results among study population. Significant univariate factors were then further analyzed by multivariable logistic regression models. Results Significant predictors of death included blood transfusion volume during operation, peak level of blood sugar and lactate during operation, the total bilirubin level and platelet count on the first day after operation, hypotension on the first day after operation, pulmonary infection, multiple organ dysfunction syndrome (MODS) and the interval time of oliguria and CRRT (P<0.05). Logistic regression showed that there were statistical differencs in hypotension on the first day after operation, postoperative platelet count, and interval time of oliguria and CRRT respectively (P<0.05). Conclusion Improving intraoperative management, reducing bleeding and blood transfusion, controlling blood sugar level, dealing with complications such as hypotension, pulmonary infection and MODS more aggressively, starting CRRT when needed may be helpful to reduce mortality. Monitoring of the blood pressure and platelet count on the first day after operation is useful for prognosis estimation.

Citation： CAO Ke, YU Hui, ZENG ling. Analysis of Risk Factors for Death in Patients Undergoing Continuous Renal Replacement Therapy after On-pump Cardiovascular Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(10): 960-964. doi: 10.7507/1007-4848.20160230 Copy

1.	Mao H, Katz N, Ariyanon W, et al. Cardiac surgery-associated acute kidney injury. Cardiorenal Med, 2013, 3(3): 178-199.
2.	Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol, 2006, 1(1): 19-32.
3.	王旭冬, 车妙琳, 谢波, 等. 急性肾损伤定义及分期系统评估心脏手术患者预后的临床价值. 中国胸心血管外科临床杂志, 2012, 19(6): 619-623.
4.	Cosentino F, Chaff C, Piedmonte M. Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant, 1994, 9(Suppl 4): 179-182.
5.	Bapat V, Sabetai M, Roxburgh J, et al. Early and intensive continuous veno-venous hemofiltration for acute renal failure after cardiac surgery. Interact Cardiovasc Thorac Surg, 2004, 3(3): 426-430.
6.	Lecomte P, Van Vlem B, Coddens J, et al. Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients. Crit Care, 2008, 12(6): R154.
7.	Feringa HH, Vidakovic R, Karagiannis SE, et al. Impaired glucose regulation, elevated glycated haemoglobin and cardiac ischaemic events in vascular surgery patients. Diabet Med, 2008, 25(3): 314-319.
8.	Hauer D, Kilger E, Kaufmann I, et al. Risk and outcome analysis of renal replacement therapies in patients after cardiac surgery with pre-operatively normal renal function. Anaesthesia, 2009, 64(6): 615-619.
9.	Allen LA, FeIker GM, Pocock S, et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity(CHARM)program. Eur J Heart Fail, 2009, 11(2): 170-177.
10.	Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology, 2011, 114(4): 964-970.
11.	丁文军, 刘华, 季强, 等. 心脏术后急性肾损伤行连续性静脉-静脉血液透析治疗失败的危险因素分析. 中华医学杂志, 2013, 93(22): 1737-1739.
12.	Ji Q, Mei YQ, Wang XS, et al. Risk factors for failure of continuous veno-venous hemodialysis in the treatment of acute renal failure following cardiac surgery. Perfusion, 2010, 25(5): 337-342.
13.	Despotis GJ, Avidan MS, Hogue CW. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg, 2001, 72(5): S1821-S1831.
14.	Ng RR, Chew ST, Liu W, et al. Identification of modifiable risk factors for acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Thorac Cardiovasc Surg, 2014, 147(4): 1356-1361.
15.	王常田, 李德闽, 申翼, 等. 心血管手术后血小板的动态变化及其与患者预后的相关性分析. 解放军医学杂志, 2010, 35(9): 1145-1147.
16.	张丽琴, 邢昌赢, 林花, 等. 重症急性肾损伤患者经连续性肾脏替代治疗后肾功能恢复的影响因素. 现代生物医学进展, 2014, 14(8): 1490-1493.
17.	Carrel T, Englberger L, Mohacsi P, et al. Low systemic vascular resistance after cardiopulmonary bypass:incidence, etiology, and clinical importance. J Card Surg, 2000, 15(5): 347-353.
18.	Fischer GW, Levin MA. Vasoplegia during cardiac surgery:current concepts and management.Semin Thorac Cardiovasc Surg, 2010, 22(2): 140-144.
19.	徐静, 沈平雁, 马晓波, 等. 连续性肾脏替代治疗患者的APACHE评分及危险因素分析. 中国血液净化, 2010, 9(7): 368-371.
20.	Bellomo R, Auriemma S, Fabbri A, et a1. The pathophysiology of cardiac surgery-associated acute kidney injury. Int J Artif Organs, 2008, 31(2): 166-178.

1. Mao H, Katz N, Ariyanon W, et al. Cardiac surgery-associated acute kidney injury. Cardiorenal Med, 2013, 3(3): 178-199.
2. Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol, 2006, 1(1): 19-32.
3. 王旭冬, 车妙琳, 谢波, 等. 急性肾损伤定义及分期系统评估心脏手术患者预后的临床价值. 中国胸心血管外科临床杂志, 2012, 19(6): 619-623.
4. Cosentino F, Chaff C, Piedmonte M. Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant, 1994, 9(Suppl 4): 179-182.
5. Bapat V, Sabetai M, Roxburgh J, et al. Early and intensive continuous veno-venous hemofiltration for acute renal failure after cardiac surgery. Interact Cardiovasc Thorac Surg, 2004, 3(3): 426-430.
6. Lecomte P, Van Vlem B, Coddens J, et al. Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients. Crit Care, 2008, 12(6): R154.
7. Feringa HH, Vidakovic R, Karagiannis SE, et al. Impaired glucose regulation, elevated glycated haemoglobin and cardiac ischaemic events in vascular surgery patients. Diabet Med, 2008, 25(3): 314-319.
8. Hauer D, Kilger E, Kaufmann I, et al. Risk and outcome analysis of renal replacement therapies in patients after cardiac surgery with pre-operatively normal renal function. Anaesthesia, 2009, 64(6): 615-619.
9. Allen LA, FeIker GM, Pocock S, et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity(CHARM)program. Eur J Heart Fail, 2009, 11(2): 170-177.
10. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology, 2011, 114(4): 964-970.
11. 丁文军, 刘华, 季强, 等. 心脏术后急性肾损伤行连续性静脉-静脉血液透析治疗失败的危险因素分析. 中华医学杂志, 2013, 93(22): 1737-1739.
12. Ji Q, Mei YQ, Wang XS, et al. Risk factors for failure of continuous veno-venous hemodialysis in the treatment of acute renal failure following cardiac surgery. Perfusion, 2010, 25(5): 337-342.
13. Despotis GJ, Avidan MS, Hogue CW. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg, 2001, 72(5): S1821-S1831.
14. Ng RR, Chew ST, Liu W, et al. Identification of modifiable risk factors for acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Thorac Cardiovasc Surg, 2014, 147(4): 1356-1361.
15. 王常田, 李德闽, 申翼, 等. 心血管手术后血小板的动态变化及其与患者预后的相关性分析. 解放军医学杂志, 2010, 35(9): 1145-1147.
16. 张丽琴, 邢昌赢, 林花, 等. 重症急性肾损伤患者经连续性肾脏替代治疗后肾功能恢复的影响因素. 现代生物医学进展, 2014, 14(8): 1490-1493.
17. Carrel T, Englberger L, Mohacsi P, et al. Low systemic vascular resistance after cardiopulmonary bypass:incidence, etiology, and clinical importance. J Card Surg, 2000, 15(5): 347-353.
18. Fischer GW, Levin MA. Vasoplegia during cardiac surgery:current concepts and management.Semin Thorac Cardiovasc Surg, 2010, 22(2): 140-144.
19. 徐静, 沈平雁, 马晓波, 等. 连续性肾脏替代治疗患者的APACHE评分及危险因素分析. 中国血液净化, 2010, 9(7): 368-371.
20. Bellomo R, Auriemma S, Fabbri A, et a1. The pathophysiology of cardiac surgery-associated acute kidney injury. Int J Artif Organs, 2008, 31(2): 166-178.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of Risk Factors for Death in Patients Undergoing Continuous Renal Replacement Therapy after On-pump Cardiovascular Surgery

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