The cardiorenal prognosis in patients underwent cardiac surgery therapy complicated by an acute kidney injury

Frequency of development of the acute kidney injury (AKI) in patients underwent different cardiac interventions, and its influence on the cardiorenal prognosis depending on initial function of kidneys is analyzed. 1126 patients (595 men and 531 women) aged from 32 till 68 years (62.3±5.2 years) at which at which prosthetics of valves of heart, coronary artery bypass grafting (CABG) and their combination are examined. In 656 patients (the 1st group) before operation the glomerular filtration rate (GFR) was upper than 60 ml/min/1.73 m2 and in 470 patients (the 2nd group) ranged from 59 to 45 ml/min/1.73 m2, determined by a formula CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). AKI was diagnosed by level of serum creatinine (sCr) using criteria of AKIN (Acute Kidney Injury Network). In early postoperative period AKI was diagnosed in 23.9% of patients in the 1st group and in 38.7% of patients in the 2nd group ( p <0.001). The frequency of the early postoperative complications was higher in the 2nd group than in the 1st group. The in-hospital mortality in the 1st group accounted for 4.9%, including patients with AKI (14.1%), and in the 2nd group - 12.1 and 18.1% respectively. By results of 12-month observation, regress of renal dysfunction in the 2nd group is noted in 47.9% of the patients with AKI and in 56.9% of patients - without AKI. On the contrary, progressing of the chronic kidney disease (CKD) in the 2nd group is revealed in 11.0% of the patients with AKI and in 4.5% - without AKI ( p =0.013). In the 2nd group the program hemodialysis in 5.2% of the patients who had AKI and in 0.7% of patients without AKI was required ( p =0.01). Within 12 months of observation after CABG adverse cardiovascular events in the 1st group in patients who had AKI were found more often than in patients without AKI, and also in the 2nd group in patients with progressing of CKD. Cardiovascular mortality within 12 months after discharge from hospital in the 1st group in the patients who had AKI accounted for 7.8%, in patients without AKI 2.0% ( p <0.01) and in the 2nd group - 11.8 and 5.2% respectively ( p <0.05). It is revealed that development of postoperative AKI and progressing of a previous CKD after cardiac surgery therapy are associated with the adverse cardiorenal prognosis.

cardiorenal prognosis, cardiac interventions, acute kidney injury, chronic kidney disease