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Title: Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation.
Austin Authors: Husain-Syed, Faeq;Ferrari, Fiorenza;Sharma, Aashish;Danesi, Tommaso Hinna;Bezerra, Pércia;Lopez-Giacoman, Salvador;Samoni, Sara;de Cal, Massimo;Corradi, Valentina;Virzì, Grazia Maria;De Rosa, Silvia;Muciño Bermejo, María Jimena;Estremadoyro, Carla;Villa, Gianluca;Zaragoza, Jose J;Caprara, Carlotta;Brocca, Alessandra;Birk, Horst-Walter;Walmrath, Hans-Dieter;Seeger, Werner;Nalesso, Federico;Zanella, Monica;Brendolan, Alessandra;Giavarina, Davide;Salvador, Loris;Bellomo, Rinaldo ;Rosner, Mitchell H;Kellum, John A;Ronco, Claudio
Affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Issue Date: 2018
Date: 2018-04
Publication information: The Annals of thoracic surgery 2018; 105(4): 1094-1101
Abstract: Although acute kidney injury (AKI) frequently complicates cardiac operations, methods to determine AKI risk in patients without underlying kidney disease are lacking. Renal functional reserve (RFR) can be used to measure the capacity of the kidney to increase glomerular filtration rate under conditions of physiologic stress and may serve as a functional marker that assesses susceptibility to injury. We sought to determine whether preoperative RFR predicts postoperative AKI. We enrolled 110 patients with normal resting glomerular filtration rates undergoing elective cardiac operation. Preoperative RFR was measured by using a high oral protein load test. The primary end point was the ability of preoperative RFR to predict AKI within 7 days of operation. Secondary end points included the ability of a risk prediction model, including demographic and comorbidity covariates, RFR, and intraoperative variables to predict AKI, and the ability of postoperative cell cycle arrest markers at various times to predict AKI. AKI occurred in 15 patients (13.6%). Preoperative RFR was lower in patients who experienced AKI (p < 0.001) and predicted AKI with an area under the receiver operating characteristic curve (AUC) of 0.83 (95% confidence interval [CI]: 0.70 to 0.96). Patients with preoperative RFRs not greater than 15 mL · min-1 · 1.73 m-2 were 11.8 times more likely to experience AKI (95% CI: 4.62 to 29.89 times, p < 0.001). In addition, immediate postoperative cell cycle arrest biomarkers predicted AKI with an AUC of 0.87. Among elective cardiac surgical patients with normal resting glomerular filtration rates, preoperative RFR was highly predictive of AKI. A reduced RFR appears to be a novel risk factor for AKI, and measurement of RFR preoperatively can identify patients who are likely to benefit from preventive measures or to select for use of biomarkers for early detection. Larger prospective studies to validate the use of RFR in strategies to prevent AKI are warranted. identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759.
DOI: 10.1016/j.athoracsur.2017.12.034
Journal: The Annals of thoracic surgery
PubMed URL: 29382510
Type: Journal Article
Appears in Collections:Journal articles

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