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Chronic progression of cardiac surgery associated acute kidney injury: Intermediary role of acute kidney disease

Authors
 Jin Sun Cho  ;  Jae-Kwang Shim  ;  Sak Lee  ;  Jong-Wook Song  ;  Nakcheol Choi  ;  Sugeun Lee  ;  Young-Lan Kwak 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.161(2) : 681-688.e3, 2021-02 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2021-02
MeSH
Acute Kidney Injury / etiology* ; Acute Kidney Injury / pathology ; Aged ; Cardiac Surgical Procedures / adverse effects* ; Disease Progression ; Female ; Heart Valves / surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications / etiology* ; Postoperative Complications / pathology ; Renal Insufficiency, Chronic / etiology ; Renal Insufficiency, Chronic / pathology ; Risk Factors
Keywords
acute kidney disease ; acute kidney injury ; chronic kidney disease ; heart failure ; valvular heart surgery
Abstract
Objective: The association between acute kidney injury (AKI) and chronic kidney disease (CKD) remains elusive in cardiac surgery. We investigated the association between postoperative AKI and CKD development, emphasizing the intermediary role of acute kidney disease (AKD), in patients undergoing valvular heart surgery. Methods: We assessed the occurrence of postoperative AKI (7 days postsurgery), AKD (3 months postsurgery), and CKD (12 months postsurgery) in 1386 patients. The primary outcome was the development of AKD and CKD according to AKI occurrence. Relevant risk factors of AKI, AKD, and CKD were identified through multivariable regression analysis. Results: AKI occurred in 23.9% of patients with normal preoperative renal function. Even with early recovery of renal function within 3 days, AKI increased the risk of AKD (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.98-5.20, P < .001) and CKD (OR, 2.86; 95% CI, 1.68-4.86, P < .001), whereas persistent AKI further increased the risk of AKD (OR, 12.07; 95% CI, 5.56-26.21, P < .001) and CKD (OR, 10.54; 95% CI, 4.01-27.76, P < .001). We also found these relationships in patients with pre-existing renal dysfunction. Multivariable analysis identified 3-month postoperative heart failure and high right ventricular systolic pressure as independent risk factors for CKD. Conclusions: Even after early recovery, postvalvular heart surgery AKI was associated with increased risk of CKD via AKD in a graded manner related to AKI severity and persistence. Postoperative cardiac dysfunction assessed 3 months postsurgery also significantly influenced CKD development, indicating a need for close follow-up of cardiac and renal function to improve patient outcomes.
Full Text
https://www.sciencedirect.com/science/article/pii/S0022522319324857
DOI
10.1016/j.jtcvs.2019.10.101
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Song, Jong Wook(송종욱) ORCID logo https://orcid.org/0000-0001-7518-2070
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Cho, Jin Sun(조진선) ORCID logo https://orcid.org/0000-0002-5408-4188
Choi, Nakcheol(최낙철) ORCID logo https://orcid.org/0000-0002-1354-6366
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182138
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