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- Title
Impact of Dilution Effect of Fluid Balance on the Early Detection of Cardiac Surgery Associated Acute Kidney Injury.
- Authors
Ji-fu Jin; Jia-rui Xu; Wu-hua Jiang; Ya-min Zhuang; Bo Shen; Jia-wei Yu; Wen-lv Lv; Chun-sheng Wang; Xiao-qiang Ding; Jie Teng
- Abstract
Objective: The volume overload of patients with cardiac surgery is common, which is closely related to the occurrence, development and prognosis of cardiac surgery associated acute kidney injury (CSA-AKI). Dilution effect of volume overload of cardiac surgery patients could delay early diagnosis of CSA-AKI. The purpose of the study was to investigate the effect of volume overload on the timing of diagnosis and prognosis of AKI with off pump coronary artery bypass grafting (OPCABG). Methods: That was a retrospective analysis and single center study. 122 consecutive patients undergoing elective OPCABG from January to June 2015 in Zhongshan hospital were enrolled in this study. AKIN criteria was used to classify CSA-AKI. Fluid input and output were recorded for 48 hours post-operatively. Urine output was recorded every 6 hours for 24 hours post-operatively. Serum creatinine was daily recorded and adjusted for weight-corrected fluid balance and patients were categorized into three groups: group A (No AKI before or after adjustment); group B (AKI only after adjustment); group C (AKI both before and after adjustment). Results: Among 122 patients with weight and baseline creatinine available, only 1 patient in group C received CRRT treatment and all patients were discharged successfully from hospital. After adjusting for weight and volume balance, the incidence of CSA-AKI increased from 18.8% (23/122) to 30.3% (37/122) (p < 0.05). In patients with AKI only after adjustment (group B), ICU stay and total hospitalization time were significantly higher than those in group A [(3.3 ± 0.9) d vs (1.8 ± 1.5) d, p < 0.05; (13.3 ± 3.7) d vs (11.3 ± 3.3) d, p < 0.05], however no significant difference was observed when compared with group C [(3.3 ± 0.9) d vs (2.5 ± 1.1) d, p > 0.05;(13.3 ± 3.7) vs (14.0 ± 2.5) d, p > 0.05]. Also, the mechanical ventilation time in group B was significantly longer than group A [(2.1 ± 0.6) d vs (1.3 ± 0.9) d, p < 0.05], but approximated that of group C (p > 0.05). Conclusion: The dilution effect of volume overload in the patients with OPCABG could influence the level of serum creatinine concentration, which might delay early classification of AKI. In order to improve the sensitivity of detection of cardiac surgery associated AKI, serum creatinine should be adjusted according to the volume balance and basic weight level.
- Subjects
ACUTE kidney failure; COMPLICATIONS of cardiac surgery; BODY fluid pressure; DILUTION; CREATININE; PROGNOSIS
- Publication
Blood Purification, 2017, Vol 43, Issue 4, p329
- ISSN
0253-5068
- Publication type
Article
- DOI
10.1159/000454755