The Clinical Course of Acute Kidney Disease after Cardiac Surgery: A Retrospective Observational Study

Ryo Matsuura, Masao Iwagami, Hidekazu Moriya, Takayasu Ohtake, Yoshifumi Hamasaki, Masaomi Nangaku, Kent Doi, Shuzo Kobayashi, Eisei Noiri, Ryo Matsuura, Masao Iwagami, Hidekazu Moriya, Takayasu Ohtake, Yoshifumi Hamasaki, Masaomi Nangaku, Kent Doi, Shuzo Kobayashi, Eisei Noiri

Abstract

Acute kidney disease (AKD), or renal dysfunction persisting >7 days after an initiating event of acute kidney injury, is a rising concern. This study aimed to elucidate the clinical course of AKD after cardiac surgery with data on post-cardiac surgery patients admitted to intensive care units (ICU) at 18 Japanese hospitals during 2012-2014. Using multivariable logistic models, we evaluated the association of AKD with 90-day mortality and the 50% eGFR decline during 2-year follow-up compared to eGFR at 90 days. AKD was defined as an elevation in serum creatinine to at least 1.5-fold from baseline in >7 days after ICU admission. Of the 3,605 eligible patients undergoing cardiac surgery, 403 patients (11.2%) had AKD. Multivariable analysis revealed that the adjusted odds ratio (OR) of AKD for 90-day mortality was 63.0 (95% confidence interval [CI], 27.9-180.6). In addition, the adjusted OR of AKD for 50% eGFR decline was 3.56 (95% CI, 2.24-5.57) among hospital survivors. In conclusion, AKD after cardiac surgery was associated with higher 90-day mortality and renal function decline after hospital discharge.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Definition of exposure and outcomes of the study. Every patient undergoing cardiac surgery was admitted to surgical ICU and evaluated for kidney function. In this study, AKI was defined as serum creatinine elevated to >0.3 mg/dL or 1.5 times higher than the baseline value within seven days after ICU admission, and AKD as an elevation in serum creatinine to at least 1.5-fold from baseline in >7 days after ICU admission. Patients were divided into three groups within seven days: those with no AKI, transient AKI (persisting for less than three days) and persistent AKI (persisting for three days or longer but less than 7). In the first analysis, AKD was evaluated for association with 90-day mortality and renal recovery from hospital discharge. In the second analysis, AKD was evaluated for association with subsequent decline of estimated glomerular filtration rate (eGFR) during the 2-year follow-up.
Figure 2
Figure 2
Patient flowchart.

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