Risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Jing ¹ ,  JIANG Yunlan ² , ZHANG Yue ¹ , LIU Yaxin ¹ , HUANG Xiaoxing ¹ , SHEN Yinli ²

1. School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P. R. China;
2. Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P. R. China;

Corresponding author：

JIANG Yunlan, Email: 18980880152@163.com

Keywords：

Off-pump coronary artery bypass grafting; acute kidney injury; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202205061

Video：

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Objective To analyze the risk factors for acute kidney injury (AKI) after off-pump coronary artery bypass grafting (OPCABG). Methods The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang data, CBM, VIP, CNKI were searched by computer for researches on risk factors associated with the development of AKI after OPCABG from the inception to March 2022. The meta-analysis was performed using RevMan 5.4 software. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies.Results A total of 18 researches were included, involving 9 risk factors. The NOS score of all included studies was≥6 points. Meta-analysis results showed that age [OR=1.03, 95%CI (1.01, 1.06), P=0.020], body mass index (BMI) [OR=1.10, 95%CI (1.05, 1.15), P<0.001], history of hypertension [OR=1.45, 95%CI (1.27, 1.66), P<0.001], history of diabetes [OR=1.50, 95%CI (1.33, 1.70), P<0.001], preoperative serum creatinine level [OR=2.05, 95%CI (1.27, 3.32), P=0.003], low left ventricular ejection fraction [OR=4.51, 95%CI (1.39, 14.65), P=0.010], preoperative coronary angiography within a short period of time [OR=2.10, 95%CI (1.52, 2.91), P<0.001], perioperative implantation of intra-aortic balloon pump [OR=3.42, 95%CI (2.26, 5.16), P<0.001], perioperative blood transfusion [OR=2.00, 95%CI (1.51, 2.65), P<0.001] were risk factors for AKI after OPCABG. Conclusion Age, BMI, history of hypertension, history of diabetes, preoperative serum creatinine level, low left ventricular ejection fraction, preoperative coronary angiography within a short period of time, perioperative implantation of intra-aortic balloon pump, perioperative blood transfusion are risk factors for AKI after OPCABG. Medical staff should focus on monitoring the above risk factors and early identifying, in order to prevent or delay the onset of postoperative AKI and promote early recovery of patients.

Citation： PAN Jing, JIANG Yunlan, ZHANG Yue, LIU Yaxin, HUANG Xiaoxing, SHEN Yinli. Risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 1048-1054. doi: 10.7507/1007-4848.202205061 Copy

1.	Park J, Lee JH, Kim KA, et al. Effects of preoperative statin on acute kidney injury after off-pump coronary artery bypass grafting. J Am Heart Assoc, 2019, 8(7): e010892.
2.	王睿, 朱一帆, 陈文, 等. 体外与非体外循环冠状动脉旁路移植术后急性肾损伤对比. 中华胸心血管外科杂志, 2019, 35(3): 167-170.
3.	Palazuelos J, Clares Montón P, Rubio Alonso M. Acute kidney injury after cardiac surgery is not always related to coronary angiography timing. J Thorac Cardiovasc Surg, 2016, 152(1): 262-263.
4.	Hong S, Youn YN, Yoo KJ. Metabolic syndrome as a risk factor for postoperative kidney injury after off-pump coronary artery bypass surgery. Circ J, 2010, 74(6): 1121-1126.
5.	Lamy A, Devereaux PJ, Prabhakaran D, et al. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med, 2013, 368(13): 1179-1188.
6.	Wang R, Wang X, Zhu Y, et al. Acute kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: A retrospective propensity score matching analysis. J Cardiothorac Surg, 2020, 15(1): 186.
7.	吴砚铭, 王彦, 李佳龙, 等. 二甲双胍与糖尿病患者食管癌发生风险及预后相关性的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2022, 29(2): 179-185.
8.	贺源, 徐红党, 林洪启, 等. 非体外循环冠状动脉旁路移植术后急性肾损伤的危险因素. 中华麻醉学杂志, 2021, 41(9): 1079-1082.
9.	董高翔, 严中亚. 不停跳冠脉搭桥术后急性肾损伤的危险因素分析. 安徽卫生职业技术学院学报, 2019, 18(2): 25-26, 29.
10.	吴婷婷, 王红, 邵涓涓, 等. 尿酸对非体外循环冠状动脉旁路移植术后急性肾损伤的影响. 中华胸心血管外科杂志, 2019, 35(5): 294-298.
11.	Liu W, Xi Z, Gu C, et al. Impact of major bleeding on the risk of acute kidney injury in patients undergoing off-pump coronary artery bypass grafting. J Thorac Dis, 2018, 10(6): 3381-3389.
12.	李西慧, 肖锋, 张思宇. 不停跳冠状动脉旁路移植术后急性肾损伤的影响因素探讨及3年随访结果. 北京大学学报(医学版), 2017, 49(1): 131-136.
13.	张智彪, 奚吉成, 王崇军, 等. 术前白蛋白与非体外循环下冠状动脉搭桥患者术后急性肾功能损伤的相关性分析. 中国临床实用医学, 2017, 8(6): 46-48.
14.	Kumada Y, Yoshitani K, Shimabara Y, et al. Perioperative risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A retrospective study. JA Clin Rep, 2017, 3(1): 55.
15.	韩增强, 陈生龙, 刘刚, 等. 非体外冠状动脉旁路移植术后急性肾损伤临床分析. 临床心血管病杂志, 2016, 32(8): 819-822.
16.	张仁腾, 王辉山, 姜辉, 等. 非体外循环冠状动脉旁路移植术后肾损伤风险因素的分析. 心肺血管病杂志, 2016, 35(4): 285-289.
17.	艾力夏提·阿里甫, 张明明, 木拉提·阿不都热合曼, 等. 非体外循环下冠状动脉旁路移植术后急性肾损伤的相关因素分析. 中国微创外科杂志, 2016, 16(3): 197-200.
18.	郭建中, 李大连, 程智广, 等. 非体外循环下冠状动脉旁路移植术后急性肾损伤危险因素分析. 国际外科学杂志, 2014, 41(11): 747-750.
19.	Song JW, Shim JK, Yoo KJ, et al. Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass. Interact Cardiovasc Thorac Surg, 2013, 17(3): 473-478.
20.	桂雷, 陈庆良, 姜楠, 等. 非体外循环冠状动脉旁路移植术后急性肾损伤的危险因素分析. 天津医药, 2012, 40(4): 387-388.
21.	Lee EH, Baek SH, Chin JH, et al. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med, 2012, 38(9): 1478-1486.
22.	Ji Q, Mei Y, Wang X, et al. Effect of elapsed time from coronary angiography until off-pump coronary artery bypass surgery on postoperative renal function. Circ J, 2012, 76(10): 2356-2362.
23.	Kim MY, Jang HR, Huh W, et al. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Ren Fail, 2011, 33(3): 316-322.
24.	Zhang Y, Ye N, Chen YP, et al. Relation between the interval from coronary angiography to selective off-pump coronary artery bypass grafting and postoperative acute kidney injury. Am J Cardiol, 2013, 112(10): 1571-1575.
25.	Hall JE, do Carmo JM, da Silva AA, et al. Obesity, kidney dysfunction and hypertension: Mechanistic links. Nat Rev Nephrol, 2019, 15(6): 367-385.
26.	Shi N, Liu K, Fan Y, et al. The association between obesity and risk of acute kidney injury after cardiac surgery. Front Endocrinol (Lausanne), 2020, 11: 534294.
27.	Yu SM, Bonventre JV. Acute kidney injury and progression of diabetic kidney disease. Adv Chronic Kidney Dis, 2018, 25(2): 166-180.
28.	Hertzberg D, Sartipy U, Holzmann MJ. Type 1 and type 2 diabetes mellitus and risk of acute kidney injury after coronary artery bypass grafting. Am Heart J, 2015, 170(5): 895-902.
29.	Schopka S, Diez C, Camboni D, et al. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: A matched pair analysis. J Cardiothorac Surg, 2014, 9: 20.
30.	唐巧, 李怡, 李贵森, 等. 急性肾损伤有关生物标志物的研究进展. 实用医院临床杂志, 2022, 19(2): 225-228.
31.	Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: Risk factors, pathophysiology and treatment. Nat Rev Nephrol, 2017, 13(11): 697-711.
32.	Lee EH, Chin JH, Joung KW, et al. Impact of the time of coronary angiography on acute kidney injury after elective off-pump coronary artery bypass surgery. Ann Thorac Surg, 2013, 96(5): 1635-1641.
33.	牛永胜, 章淬, 薛寅莹, 等. 冠状动脉旁路移植术后急性肾损伤的危险因素临床分析. 国际外科学杂志, 2014, 41(12): 820-823.
34.	张万程, 孙俊杰, 鲁显慧, 等. 高危老年患者行冠状动脉搭桥术后急性肾损伤的危险因素分析. 临床心血管病杂志, 2019, 35(1): 65-69.

1. Park J, Lee JH, Kim KA, et al. Effects of preoperative statin on acute kidney injury after off-pump coronary artery bypass grafting. J Am Heart Assoc, 2019, 8(7): e010892.
2. 王睿, 朱一帆, 陈文, 等. 体外与非体外循环冠状动脉旁路移植术后急性肾损伤对比. 中华胸心血管外科杂志, 2019, 35(3): 167-170.
3. Palazuelos J, Clares Montón P, Rubio Alonso M. Acute kidney injury after cardiac surgery is not always related to coronary angiography timing. J Thorac Cardiovasc Surg, 2016, 152(1): 262-263.
4. Hong S, Youn YN, Yoo KJ. Metabolic syndrome as a risk factor for postoperative kidney injury after off-pump coronary artery bypass surgery. Circ J, 2010, 74(6): 1121-1126.
5. Lamy A, Devereaux PJ, Prabhakaran D, et al. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med, 2013, 368(13): 1179-1188.
6. Wang R, Wang X, Zhu Y, et al. Acute kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: A retrospective propensity score matching analysis. J Cardiothorac Surg, 2020, 15(1): 186.
7. 吴砚铭, 王彦, 李佳龙, 等. 二甲双胍与糖尿病患者食管癌发生风险及预后相关性的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2022, 29(2): 179-185.
8. 贺源, 徐红党, 林洪启, 等. 非体外循环冠状动脉旁路移植术后急性肾损伤的危险因素. 中华麻醉学杂志, 2021, 41(9): 1079-1082.
9. 董高翔, 严中亚. 不停跳冠脉搭桥术后急性肾损伤的危险因素分析. 安徽卫生职业技术学院学报, 2019, 18(2): 25-26, 29.
10. 吴婷婷, 王红, 邵涓涓, 等. 尿酸对非体外循环冠状动脉旁路移植术后急性肾损伤的影响. 中华胸心血管外科杂志, 2019, 35(5): 294-298.
11. Liu W, Xi Z, Gu C, et al. Impact of major bleeding on the risk of acute kidney injury in patients undergoing off-pump coronary artery bypass grafting. J Thorac Dis, 2018, 10(6): 3381-3389.
12. 李西慧, 肖锋, 张思宇. 不停跳冠状动脉旁路移植术后急性肾损伤的影响因素探讨及3年随访结果. 北京大学学报(医学版), 2017, 49(1): 131-136.
13. 张智彪, 奚吉成, 王崇军, 等. 术前白蛋白与非体外循环下冠状动脉搭桥患者术后急性肾功能损伤的相关性分析. 中国临床实用医学, 2017, 8(6): 46-48.
14. Kumada Y, Yoshitani K, Shimabara Y, et al. Perioperative risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A retrospective study. JA Clin Rep, 2017, 3(1): 55.
15. 韩增强, 陈生龙, 刘刚, 等. 非体外冠状动脉旁路移植术后急性肾损伤临床分析. 临床心血管病杂志, 2016, 32(8): 819-822.
16. 张仁腾, 王辉山, 姜辉, 等. 非体外循环冠状动脉旁路移植术后肾损伤风险因素的分析. 心肺血管病杂志, 2016, 35(4): 285-289.
17. 艾力夏提·阿里甫, 张明明, 木拉提·阿不都热合曼, 等. 非体外循环下冠状动脉旁路移植术后急性肾损伤的相关因素分析. 中国微创外科杂志, 2016, 16(3): 197-200.
18. 郭建中, 李大连, 程智广, 等. 非体外循环下冠状动脉旁路移植术后急性肾损伤危险因素分析. 国际外科学杂志, 2014, 41(11): 747-750.
19. Song JW, Shim JK, Yoo KJ, et al. Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass. Interact Cardiovasc Thorac Surg, 2013, 17(3): 473-478.
20. 桂雷, 陈庆良, 姜楠, 等. 非体外循环冠状动脉旁路移植术后急性肾损伤的危险因素分析. 天津医药, 2012, 40(4): 387-388.
21. Lee EH, Baek SH, Chin JH, et al. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med, 2012, 38(9): 1478-1486.
22. Ji Q, Mei Y, Wang X, et al. Effect of elapsed time from coronary angiography until off-pump coronary artery bypass surgery on postoperative renal function. Circ J, 2012, 76(10): 2356-2362.
23. Kim MY, Jang HR, Huh W, et al. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Ren Fail, 2011, 33(3): 316-322.
24. Zhang Y, Ye N, Chen YP, et al. Relation between the interval from coronary angiography to selective off-pump coronary artery bypass grafting and postoperative acute kidney injury. Am J Cardiol, 2013, 112(10): 1571-1575.
25. Hall JE, do Carmo JM, da Silva AA, et al. Obesity, kidney dysfunction and hypertension: Mechanistic links. Nat Rev Nephrol, 2019, 15(6): 367-385.
26. Shi N, Liu K, Fan Y, et al. The association between obesity and risk of acute kidney injury after cardiac surgery. Front Endocrinol (Lausanne), 2020, 11: 534294.
27. Yu SM, Bonventre JV. Acute kidney injury and progression of diabetic kidney disease. Adv Chronic Kidney Dis, 2018, 25(2): 166-180.
28. Hertzberg D, Sartipy U, Holzmann MJ. Type 1 and type 2 diabetes mellitus and risk of acute kidney injury after coronary artery bypass grafting. Am Heart J, 2015, 170(5): 895-902.
29. Schopka S, Diez C, Camboni D, et al. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: A matched pair analysis. J Cardiothorac Surg, 2014, 9: 20.
30. 唐巧, 李怡, 李贵森, 等. 急性肾损伤有关生物标志物的研究进展. 实用医院临床杂志, 2022, 19(2): 225-228.
31. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: Risk factors, pathophysiology and treatment. Nat Rev Nephrol, 2017, 13(11): 697-711.
32. Lee EH, Chin JH, Joung KW, et al. Impact of the time of coronary angiography on acute kidney injury after elective off-pump coronary artery bypass surgery. Ann Thorac Surg, 2013, 96(5): 1635-1641.
33. 牛永胜, 章淬, 薛寅莹, 等. 冠状动脉旁路移植术后急性肾损伤的危险因素临床分析. 国际外科学杂志, 2014, 41(12): 820-823.
34. 张万程, 孙俊杰, 鲁显慧, 等. 高危老年患者行冠状动脉搭桥术后急性肾损伤的危险因素分析. 临床心血管病杂志, 2019, 35(1): 65-69.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A systematic review and meta-analysis

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