Correlation between preoperative coronary angiography and postoperative acute kidney injury in cardiac surgery: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Changying ¹ , YAN Yang ¹ , SHI Tao ¹ , LI Yongxin ¹ , LI Jing ¹ , LIU Wenyan ² , LIU Miaomiao ¹ ,  ZHENG Xinglong ¹

1. Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, P. R. China;
2. Department of Blood Purification, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, P. R. China;

Corresponding author：

ZHENG Xinglong, Email: zhengxinglongmay@163.com

Keywords：

Acute kidney injury; coronary angiography; cardiac surgery; risk factors

DOI：

10.7507/1007-4848.202302046

Video：

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Objective To explore the relationship between preoperative coronary angiography and postoperative acute kidney injury (AKI) in cardiac surgery. Methods The clinical data of patients who underwent coronary angiography within 30 days before cardiac surgery in the First Affiliated Hospital of Xi’an Jiaotong University from January 2015 to April 2019 were retrospectively analyzed. Univariate analysis and multivariate logistic regression analyses were used to explore the relationship between the interval from preoperative coronary angiography to cardiac surgery and postoperative AKI. Results Finally 1 112 patients were collected, including 700 males and 412 females, with a median age of 61 (55, 66) years. The incidence of postoperative AKI was 40.8%, of which grade 2-3 AKI accounted for 11.9%. Multivariate analysis showed that age (OR=1.049, 95%CI 1.022-1.077, P<0.001), body mass index (OR=1.065, 95%CI 1.010-1.123, P=0.020) and time interval between preoperative coronary angiography and cardiac surgery within 24 hours (OR=1.625, 95%CI 1.116-2.364, P=0.011) were independent predictors of postoperative AKI. Patients who underwent coronary angiography within 24 hours before surgery had a 10.6% higher incidence of postoperative AKI compared to those who underwent angiography more than 24 hours before surgery (P=0.004). Patients who underwent valve surgery with or without coronary artery bypass grafting (CABG) had a higher risk of AKI than those who only underwent CABG. The in-hospital stay of patients who developed AKI was 2 days longer than those without AKI. However, undergoing coronary angiography within 24 hours before cardiac surgery did not prolong the length of ICU stay or hospital stay, nor did it increase the risk of death or renal failure after the operation. Conclusion Undergoing coronary angiography within 24 hours before cardiac surgery increases the risk of postoperative AKI.

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2.	Boyer N, Eldridge J, Prowle JR, et al. Postoperative acute kidney injury. Clin J Am Soc Nephrol, 2022, 17(10): 1535-1545.
3.	Massoth C, Zarbock A, Meersch M. Acute kidney injury in cardiac surgery. Crit Care Clin, 2021, 37(2): 267-278.
4.	Demirjian S, Bashour CA, Shaw A, et al. Predictive accuracy of a perioperative laboratory test-based prediction model for moderate to severe acute kidney injury after cardiac surgery. JAMA, 2022, 327(10): 956-964.
5.	Dodson JA, Hajduk A, Curtis J, et al. Acute kidney injury among older patients undergoing coronary angiography for acute myocardial infarction: The SILVER-AMI study. Am J Med, 2019, 132(12): e817-e826.
6.	Janssens GN, Daemen J, Lemkes JS, et al. The influence of timing of coronary angiography on acute kidney injury in out-of-hospital cardiac arrest patients: A retrospective cohort study. Ann Intensive Care, 2022, 12(1): 12.
7.	Zhou D, Lun Z, Wang B, et al. Association between non-recovered contrast-associated acute kidney injury and poor prognosis in patients undergoing coronary angiography. Front Cardiovasc Med, 2022, 9: 823829.
8.	Azzalini L, Candilio L, McCullough PA, et al. Current risk of contrast-induced acute kidney injury after coronary angiography and intervention: A reappraisal of the literature. Can J Cardiol, 2017, 33(10): 1225-1228.
9.	Jiang H, Li D, Xu T, et al. Systemic immune-inflammation index predicts contrast-induced acute kidney injury in patients undergoing coronary angiography: A cross-sectional study. Front Med (Lausanne), 2022, 9: 841601.
10.	Peng K, McIlroy DR, Bollen BA, et al. Society of Cardiovascular Anesthesiologists clinical practice update for management of acute kidney injury associated with cardiac surgery. Anesth Analg, 2022, 135(4): 744-756.
11.	Tang C, Hu Y, Gao J, et al. Dexmedetomidine pretreatment attenuates myocardial ischemia reperfusion induced acute kidney injury and endoplasmic reticulum stress in human and rat. Life Sci, 2020, 257: 118004.
12.	Leballo G, Moutlana HJ, Muteba MK, et al. Factors associated with acute kidney injury and mortality during cardiac surgery. Cardiovasc J Afr, 2021, 32(6): 308-313.
13.	Silverton NA, Hall IE, Melendez NP, et al. Intraoperative urinary biomarkers and acute kidney injury after cardiac surgery. J Cardiothorac Vasc Anesth, 2021, 35(6): 1691-1700.
14.	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.
15.	Al-Naimi MS, Rasheed HA, Hussien NR, et al. Nephrotoxicity: Role and significance of renal biomarkers in the early detection of acute renal injury. J Adv Pharm Technol Res, 2019, 10(3): 95-99.
16.	Fan PC, Chang CH, Chen YC. Biomarkers for acute cardiorenal syndrome. Nephrology (Carlton), 2018, 23 Suppl 4: 68-71.
17.	Moledina DG, Parikh CR. Phenotyping of acute kidney injury: Beyond serum creatinine. Semin Nephrol, 2018, 38(1): 3-11.
18.	Hong C, Zhu Q, Li Y, et al. Acute kidney injury defined by cystatin C may be superior for predicting the outcomes of liver cirrhosis with acute gastrointestinal bleeding. Ren Fail, 2022, 44(1): 398-406.
19.	Ranucci M, Ballotta A, Agnelli B, et al. Acute kidney injury in patients undergoing cardiac surgery and coronary angiography on the same day. Ann Thorac Surg, 2013, 95(2): 513-519.
20.	Tecson KM, Brown D, Choi JW, et al. Major adverse renal and cardiac events after coronary angiography and cardiac surgery. Ann Thorac Surg, 2018, 105(6): 1724-1730.
21.	Liu K, Li M, Li L, et al. The effect of coronary angiography timing on cardiac surgery associated acute kidney injury incidence and prognosis. Front Med (Lausanne), 2021, 8: 619210.
22.	Thiele RH, Isbell JM, Rosner MH. AKI associated with cardiac surgery. Clin J Am Soc Nephrol, 2015, 10(3): 500-514.
23.	Borde DP, Asegaonkar B, Apsingekar P, et al. Influence of time interval between coronary angiography to off-pump coronary artery bypass surgery on incidence of cardiac surgery associated acute kidney injury. Indian J Anaesth, 2019, 63(6): 475-484.
24.	Kim K, Joung KW, Ji SM, et al. The effect of coronary angiography timing and use of cardiopulmonary bypass on acute kidney injury after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2016, 152(1): 254-261.
25.	Yue Z, Yan-Meng G, Ji-Zhuang L. Prediction model for acute kidney injury after coronary artery bypass grafting: A retrospective study. Int Urol Nephrol, 2019, 51(9): 1605-1611.
26.	Ghincea CV, Reece TB, Eldeiry M, et al. Predictors of acute kidney injury following aortic arch surgery. J Surg Res, 2019, 242: 40-46.
27.	Karim HM, Yunus M, Saikia MK, et al. Incidence and progression of cardiac surgery-associated acute kidney injury and its relationship with bypass and cross clamp time. Ann Card Anaesth, 2017, 20(1): 22-27.

1. Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet, 2019, 394(10212): 1949-1964.
2. Boyer N, Eldridge J, Prowle JR, et al. Postoperative acute kidney injury. Clin J Am Soc Nephrol, 2022, 17(10): 1535-1545.
3. Massoth C, Zarbock A, Meersch M. Acute kidney injury in cardiac surgery. Crit Care Clin, 2021, 37(2): 267-278.
4. Demirjian S, Bashour CA, Shaw A, et al. Predictive accuracy of a perioperative laboratory test-based prediction model for moderate to severe acute kidney injury after cardiac surgery. JAMA, 2022, 327(10): 956-964.
5. Dodson JA, Hajduk A, Curtis J, et al. Acute kidney injury among older patients undergoing coronary angiography for acute myocardial infarction: The SILVER-AMI study. Am J Med, 2019, 132(12): e817-e826.
6. Janssens GN, Daemen J, Lemkes JS, et al. The influence of timing of coronary angiography on acute kidney injury in out-of-hospital cardiac arrest patients: A retrospective cohort study. Ann Intensive Care, 2022, 12(1): 12.
7. Zhou D, Lun Z, Wang B, et al. Association between non-recovered contrast-associated acute kidney injury and poor prognosis in patients undergoing coronary angiography. Front Cardiovasc Med, 2022, 9: 823829.
8. Azzalini L, Candilio L, McCullough PA, et al. Current risk of contrast-induced acute kidney injury after coronary angiography and intervention: A reappraisal of the literature. Can J Cardiol, 2017, 33(10): 1225-1228.
9. Jiang H, Li D, Xu T, et al. Systemic immune-inflammation index predicts contrast-induced acute kidney injury in patients undergoing coronary angiography: A cross-sectional study. Front Med (Lausanne), 2022, 9: 841601.
10. Peng K, McIlroy DR, Bollen BA, et al. Society of Cardiovascular Anesthesiologists clinical practice update for management of acute kidney injury associated with cardiac surgery. Anesth Analg, 2022, 135(4): 744-756.
11. Tang C, Hu Y, Gao J, et al. Dexmedetomidine pretreatment attenuates myocardial ischemia reperfusion induced acute kidney injury and endoplasmic reticulum stress in human and rat. Life Sci, 2020, 257: 118004.
12. Leballo G, Moutlana HJ, Muteba MK, et al. Factors associated with acute kidney injury and mortality during cardiac surgery. Cardiovasc J Afr, 2021, 32(6): 308-313.
13. Silverton NA, Hall IE, Melendez NP, et al. Intraoperative urinary biomarkers and acute kidney injury after cardiac surgery. J Cardiothorac Vasc Anesth, 2021, 35(6): 1691-1700.
14. 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.
15. Al-Naimi MS, Rasheed HA, Hussien NR, et al. Nephrotoxicity: Role and significance of renal biomarkers in the early detection of acute renal injury. J Adv Pharm Technol Res, 2019, 10(3): 95-99.
16. Fan PC, Chang CH, Chen YC. Biomarkers for acute cardiorenal syndrome. Nephrology (Carlton), 2018, 23 Suppl 4: 68-71.
17. Moledina DG, Parikh CR. Phenotyping of acute kidney injury: Beyond serum creatinine. Semin Nephrol, 2018, 38(1): 3-11.
18. Hong C, Zhu Q, Li Y, et al. Acute kidney injury defined by cystatin C may be superior for predicting the outcomes of liver cirrhosis with acute gastrointestinal bleeding. Ren Fail, 2022, 44(1): 398-406.
19. Ranucci M, Ballotta A, Agnelli B, et al. Acute kidney injury in patients undergoing cardiac surgery and coronary angiography on the same day. Ann Thorac Surg, 2013, 95(2): 513-519.
20. Tecson KM, Brown D, Choi JW, et al. Major adverse renal and cardiac events after coronary angiography and cardiac surgery. Ann Thorac Surg, 2018, 105(6): 1724-1730.
21. Liu K, Li M, Li L, et al. The effect of coronary angiography timing on cardiac surgery associated acute kidney injury incidence and prognosis. Front Med (Lausanne), 2021, 8: 619210.
22. Thiele RH, Isbell JM, Rosner MH. AKI associated with cardiac surgery. Clin J Am Soc Nephrol, 2015, 10(3): 500-514.
23. Borde DP, Asegaonkar B, Apsingekar P, et al. Influence of time interval between coronary angiography to off-pump coronary artery bypass surgery on incidence of cardiac surgery associated acute kidney injury. Indian J Anaesth, 2019, 63(6): 475-484.
24. Kim K, Joung KW, Ji SM, et al. The effect of coronary angiography timing and use of cardiopulmonary bypass on acute kidney injury after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2016, 152(1): 254-261.
25. Yue Z, Yan-Meng G, Ji-Zhuang L. Prediction model for acute kidney injury after coronary artery bypass grafting: A retrospective study. Int Urol Nephrol, 2019, 51(9): 1605-1611.
26. Ghincea CV, Reece TB, Eldeiry M, et al. Predictors of acute kidney injury following aortic arch surgery. J Surg Res, 2019, 242: 40-46.
27. Karim HM, Yunus M, Saikia MK, et al. Incidence and progression of cardiac surgery-associated acute kidney injury and its relationship with bypass and cross clamp time. Ann Card Anaesth, 2017, 20(1): 22-27.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesCorrelation between preoperative coronary angiography and postoperative acute kidney injury in cardiac surgery: A retrospective study in a single center

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