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Abstract: TH-PO074

AKI Following Cardiac Bypass Surgery in Jamaica: Observations from a Low-Resource Country

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Fisher, Lori- Ann M., University Hospital of the West Indies, Kingston, Jamaica
  • Stephenson, Sunil, University of the West Indies, Bridgetown, Barbados
  • Tulloch-Reid, Marshall Kerr, The University of the West Indies, Kingston, Jamaica
  • Anderson, Simon G., University of the West Indies, Bridgetown, Barbados
Background

AKI following cardiac surgery requiring cardiopulmonary bypass (CPB) is a common but serious complication with an incidence of 25-40%. It is associated with a 3 to 8 times increase in mortality, increased hospital length of stay and Chronic Kidney Disease. Little is known about the incidence and impact of AKI following CPB in the Caribbean. We describe the incidence and outcomes of AKI following CPB at a referral cardiac surgery centre in the Caribbean.

Methods

Medical records of adult patients with no prior ESRD or dialysis requirement who underwent cardiac surgery requiring CPB at the University Hospital from January 1, 2016 to December 31, 2017 were reviewed. All cause mortality was the defined end-point. Demographics, pre-operative status, intraoperative and post operative data were abstracted by two independent reviewers. AKI was based on KDIGO criteria using serum creatinine measurements obtained within 72 hours post-operatively. Multivariate logistic regression was used to examine the risk factors for and impact of AKI on all-cause mortality

Results

125 patients (57% male) with mean age 57.4±12.9 years and mean pre-operative creatinine levels of 84.6 ± 33.7 μmol/L underwent cardiac surgery. The incidence of AKI was 31.2% (39/125), Of these 41% (16/39) were KDIGO I, 23% (9/39) KDIGO II and (14/39) 36% KDIGO III. Renal replacement therapy was required in 4% (5) of patients. In logistic regression analyses male sex (OR 0.46,95%CI: 0.2-0.9), and higher preoperative haemoglobin (OR 0.69,95% CI: 0.5-0.9) reduced the likelihood of AKI, whereas preoperative CKD (eGFR<60) (OR 8.6, [95% CI:1.7-43.6]) and prolonged bypass time (OR per 1 hour=2.9[95% CI 1.18-7.2]) increased risk. There was no association of age, cross clamp time or type of surgery (valve replacement or CABG) with AKI. Approximately 21%[26/125] of patients died in hospital. AKI was associated with four fold increased risk for death after adjusting for age and sex (OR[95% CI]=4.2[1.6-10.5])

Conclusion

The incidence of AKI following CPB is similar in our cohort to that reported in high income countries and significantly increases the risk of in hospital mortality. Larger multicentre prospective studies to predict risk, identify interventions to reduce mortality and assess long term complications of AKI following CPB in low resource countries are needed.