Unrecognized Impaired Renal Function In Cardiac Surgery
Mattia Scognamiglio, Maria Cristina Conti, Luigi Chiariello, Anna Elvira Ferrara, Francesco Amendolara, Ahmed Desoky.
Clinica Mediterranea Spa, Napoli, Italy.
Background Impaired renal function is a major risk factor in patients undergoing cardiac surgery and may precipitate into AKI (Acute Kidney Injury). Routinary blood tests may not reveal a latent renal insufficiency. We tried to identify patients with UIRF (Unrecognized Impaired Renal Function) to assess the risk of AKI. Methods Between January 1st, 2015 and December 31, 2016, 135 patients underwent isolated ministernotomy aortic valve replacement. According to eGFR values, 3 groups were identified: (A) 91 patients with normal renal function (B) 8 patients with renal insufficiency, (C) 33 patients with unrecognized impaired renal function (eGFR &it 60 mL/min/1.73 m2 with serum creatinine ≥ 1.2 mg/dl). Postoperatively serum creatinine level, eGFR and urine output were obtained. Primary endpoint, was a development of AKI. Secondary endpoints were postoperative complications: ICU long stay or death. Continuous variables are presented as mean values with standard deviation or median with interquartile range and were examined using the Studentís t-test. Categorical variables were displayed as real numbers and percentages and were evaluated using x2-tests. Results Overall mortality was 5 patients (3.7%), 3 in group B and 2 in group C. 26.6% of patients presented UIRF (Group C). These patients risk to develop AKI was more than double compared to patients with normal renal function (42.8% vs 16.5%). Elevated BUN values further increased risk of AKI (OR 2.84, p = 0.02). Severe renal injury, requiring replacement therapy, occurred in 16.6% of Group C patients. Patients with UIRF required longer ICU-stay compared to Group A patients (3.6 versus 1.6 days). Conclusions Patients with UIRF have a higher risk of developing AKI. Routine biochemical tests, such serum creatinine, BUN and especially eGFR, seem predictive of AKI, allowing early identification of patients at risk, and timely treatment.
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