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Abstract: FR-PO081

Recovery of AKI After Cardiac Surgery

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Sakhuja, Ankit, West Virginia University, Morgantown, West Virginia, United States
  • Priyanka, Priyanka, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background

Acute kidney injury (AKI) is a common complication after cardiac surgery. Development of this cardiac surgery associated AKI (CSA-AKI) is associated with increased mortality and healthcare costs. AKI lasting longer than 3 days (non-recovery) is associated with worse outcomes. There is, however, a lack of studies looking into epidemiology of recovery of CSA-AKI.

Methods

This was a retrospective observational study using data from High-Density Intensive Care -15 Database from University of Pittsburgh Medical Center. Data from 2008 – 2014 was included for this study. Patients undergoing cardiac surgery were identified using ICD-9-CM codes. AKI was identified using KDIGO criteria. Patients with continued AKI at discharge were identified as having acute kidney disease (AKD). Missing variables were imported using Multivariate Imputation by Chained Equation (MICE). We used Kruskal-Wallis and Chi-Square/Fisher Exact tests to compare continuous and categorical variables respectively. We used multivariable logistic regression models to identify risk factors for development of non-recovery of AKI and AKD after cardiac surgery.

Results

Among 6,440 patients, 5228 (81.9%) developed CSA-AKI. Of those who developed CSA-AKI, 98.2% developed it within 72 hours after cardiac surgery. We found that 84% of CSA-AKI was transient, resolving within 72 hours. AKI that persisted for more than 3 days (non-recovery) was about as likely to be seen with serum creatinine as with urine output, whereas transient AKI was more likely to be urine output based. Risk factors for non-recovery of AKI included thrombocytopenia, congestive heart failure, chronic obstructive pulmonary disease, CABG combined with valve surgery, black race and emergent admission. Development of AKD was seen in less than 10% patients. Risk factors for development of AKD included longer duration of surgery, congestive heart failure, use of intra-aortic balloon pump, black race and emergent admission.

Conclusion

AKI is very common after cardiac surgery but majority of it resolved within 3 days of onset. Transient AKI is more often associated with isolated oliguria, whereas non-recovery is about as likely to be seen with oliguria and as with azotemia.

Funding

  • Commercial Support