Top

Journal of Cardiothoracic Surgery

Published in:

Open Access 01-12-2014 | Research article

Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis

Authors: Simon Schopka, Claudius Diez, Daniele Camboni, Bernhard Floerchinger, Christof Schmid, Michael Hilker

Published in: Journal of Cardiothoracic Surgery | Issue 1/2014

Abstract

Background

Postoperative Acute Kidney Injury (AKI) after coronary artery bypass grafting (CABG) is a common complication associated with significant morbidity and mortality. Cardiopulmonary bypass (CPB) is accepted to contribute to the occurrence of AKI and is of particular importance as it can be avoided by using the off-pump technique. However the renoprotective properties of off-pump (CABG) are controversial. This analysis evaluates the impact of cardiopulmonary bypass on renal function.

Methods

A matched-pair analysis of 1428 patients undergoing coronary artery bypass grafting was conducted. The patients were stratified according to their preoperative renal function and to risk factors for postoperative AKI. The development of the glomerular filtration rate (GFR) from before surgery until hospital discharge was analyzed. Incidence of AKI were analyzed. Furthermore the impact of CPB duration on postoperative GFR was assessed.

Results

The occurrence of AKI increases the risk of thirty-day mortality (odds ratio of 4.3). The postoperative GFR decreases significantly after coronary artery bypass grafting but does not differ between onpump and offpump CABG (60.2 ± 24.5 vs 60.7 ± 24.8; p = 0.54). No difference regarding the incidence (26.6% vs 25%) and severity of AKI between cardiopulmonary bypass and the off-pump technique could be found. Duration of cardiopulmonary bypass does not correlate with the decline in postoperative glomerular filtration rate (Pearson Product Moment Correlation; p > 0.050).

Conclusion

Neither the mere use nor duration of cardiopulmonary bypass proofed to be a risk factor for developing postoperative AKI in CABG patients with a comparable preoperative risk profile for postoperative renal dysfunction. Furthermore, the severity of postoperative AKI is not affected by the use of cardiopulmonary bypass.

Available only for authorised users

Loef BG, Epema AH, Smilde TD, Henning RH, Ebels T, Navis G, Stegemann C: Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol. 2005, 16: 195-200.CrossRefPubMed

Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M: Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004, 15: 1597-1605. 10.1097/01.ASN.0000130340.93930.DD.CrossRefPubMed

Tolpin D, Collard C, Lee V, Virani S, Allison P, Elayda A: Subclinical changes in serum creatinine and mortality after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2012, 143: 682-688. 10.1016/j.jtcvs.2011.09.044.CrossRefPubMed

Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD: On-pump versus off- pump coronary revascularisation: evaluation of renal function. Ann Thorac Surg. 1999, 68: 493-498. 10.1016/S0003-4975(99)00566-4.CrossRefPubMed

Gamoso MG, Phillips-Bute B, Landolfo KP, Newman MF, Stafford-Smith M: Off-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction. Anaesth Analg. 2000, 91: 1080-1084.

Hilker M, Arlt M, Keyser A, Schopka S, Klose A, Diez C, Schmid C: Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational analysis. J Cardiothorac Surg. 2010, 25: 5-14.

Puehler T, Haneya A, Philipp A, Wiebe K, Keyser A, Rupprecht L, Hirt S, Kobuch R, Diez C, Hilker M, Schmid C: Minimal extracorporeal circulation: an alternative for on- pump and off-pump coronary revascularization. Ann Thorac Surg. 2009, 87: 766-772. 10.1016/j.athoracsur.2008.11.050.CrossRefPubMed

Mehta RL, Kellum JA, Shah SV: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007, 11: R31-10.1186/cc5713.CrossRefPubMedPubMedCentral

Levey AS, Coresh J, Greene T: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006, 145: 247-254. 10.7326/0003-4819-145-4-200608150-00004.CrossRefPubMed

10.

Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT: Renal dysfunction after myocardial revascularization: Risk factors, adverse outcomes and hospital resource utilization. Ann Intern Med. 1998, 128: 194-203. 10.7326/0003-4819-128-3-199802010-00005. 10CrossRefPubMed

11.

Abel RM, Buckley MJ, Austen WG, Barnett GO, Beck CH, Fischer JE: Etiology, incidence and prognosis of renal failure following cardiac surgeries. Results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg. 1976, 71: 323-333.PubMed

12.

Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J: Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998, 104: 343-348. 10.1016/S0002-9343(98)00058-8.CrossRefPubMed

13.

Massoudy P, Wagner S, Thielmann M, Herold U, Kottenberg-Assenmacher E, Marggraf G, Kribben A, Philipp T, Jakob H, Herget-Rosenthal S: Coronary artery bypass surgery and acute kidney injury—impact of the off-pump technique. Nephrol Dial Transplant. 2008, 23: 2853-2860. 10.1093/ndt/gfn153.CrossRefPubMed

14.

Chertow GM, Lazarus JM, Christiansen CL: Preoperative renal risk stratification. Circulation. 1997, 95: 878-884. 10.1161/01.CIR.95.4.878.CrossRefPubMed

15.

Conlon PJ, Stafford-Smith M, White WD: Acute renal failure following cardiac surgery. Nephrol Dial Transplant. 1999, 14: 1158-1162. 10.1093/ndt/14.5.1158.CrossRefPubMed

16.

Slogoff S, Reul GJ, Keats AS, Curry GR, Crum ME, Elmquist BA, Giesecke NM, Jistel JR, Rogers LK, Soderberg JD: Role of perfusion pressure and flow in major organ dysfunction after cardiopulmonary bypass. Ann Thorac Surg. 1990, 50: 911-918. 10.1016/0003-4975(90)91118-U.CrossRefPubMed

17.

Diez C, Haneya A, Brunger F, Philipp A, Hirt S, Ruppecht L, Kobuch R, Keyser A, Hilker M, Puehler T, Schmid C: Minimized extracorporeal circulation cannot prevent acute kidney injury but attenuates early renal dysfunction after coronary bypass grafting. ASAIO. 2009, 55: 602-607. 10.1097/MAT.0b013e3181bbcd3e.CrossRef

18.

Kolh P, Wijns W, Danchin N, Di Mario C, Falk V, Folliguet T, Garg S, Huber K, James S, Knuuti J, Lopez- Sendon J, Marco J, Menicanti L, Ostojic M, Piepoli M, Pirlet C, Pomar J, Reifart N, Ribichini F, Schalij M, Sergeant P, Serruys P, Silber S, Sousa Uva M, Taggart D, The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI), Authors/Task Force Members: Guidelines on myocardial revascularization. Eur J Cardiothorac Surg. 2010, 38: 1-52. 10.1016/j.ejcts.2010.01.051.CrossRef

19.

Loef BG, Epema AH, Navis G, Ebels T, van Oeveren W, Henning RH: Off-pump coronary revascularization attenuates transient renal damage compared with on- pump coronary revascularization. Chest. 2002, 121: 1190-1194. 10.1378/chest.121.4.1190.CrossRefPubMed

20.

Schwann NM, Horrow JC, Strong MD, Chamchad D, Guerraty A, Wechsler AS: Does off-pump coronary artery bypass reduce the incidence of clinically evident renal dysfunction after multivessel myocardial revascularization?. Anesth Analg. 2004, 99: 959-964. 10.1213/01.ANE.0000132978.32215.2C.CrossRefPubMed

21.

Beauford RB, Saunders CR, Niemeier LA, Lunceford TA, Karanam R, Prendergast T, Shah S, Burns P, Sardari F, Goldstein DJ: Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?. Heart Surg Forum. 2004, 7: E141-E146.CrossRefPubMed

22.

Stallwood MI, Grayson AD, Mills K, Scawn ND: Acute renal failure in coronary artery bypass surgery: Independent effect of cardiopulmonary bypass. Ann Thorac Surg. 2004, 77: 968-972. 10.1016/j.athoracsur.2003.09.063.CrossRefPubMed

23.

Tuttle KR, Worrall NK, Dahlstrom LR, Nandagopal R, Kausz AT, Davis CL: Predictors of ARF after cardiac surgical procedures. Am J Kidney Dis. 2003, 41: 76-83. 10.1053/ajkd.2003.50025.CrossRefPubMed

24.

Fischer UM, Weissenberger WK, Warters RD, Geissler HJ, Allen SJ, Mehlhorn U: Impact of cardiopulmonary bypass management on postcardiac surgery renal function. Perfusion. 2002, 17: 401-406. 10.1191/0267659102pf610oa.CrossRefPubMed

Title: Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis
Authors: Simon Schopka
Claudius Diez
Daniele Camboni
Bernhard Floerchinger
Christof Schmid
Michael Hilker
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2014
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/1749-8090-9-20

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2014

Aortic coarctation: guidelines mismatch across the ocean

High plasma levels of high mobility group box 1 is associated with the risk of sepsis in severe blunt chest trauma patients: a prospective cohort study

Left upper lobectomy can be a risk factor for thrombosis in the pulmonary vein stump

Complete thoracoscopic enucleation of giant leiomyoma of the esophagus: a case report and review of the literature

A rare case of sinus of valsalva-right atrial fistula secondary to an abscess perforation from underlying aortic valve endocarditis

Postoperative complications do not influence the pattern of early lung function recovery after lung resection for lung cancer in patients at risk