The effects of perioperative goal-directed therapy on acute kidney injury after cardiac surgery in the early period

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Abstract

Background: This study aims to investigate the effects of goaldirected fluid therapy on the development of acute kidney injury in the perioperative period in patients undergoing cardiopulmonary bypass.

Methods: Between November 2019 and May 2021, a total of 60 patients (46 males, 14 females; mean age: 62.5±9.6 years; range, 44 to 76 years) who were scheduled for elective coronary artery bypass grafting or valve surgery under cardiopulmonary bypass were included in the study. The patients were divided into two groups as the study group (Group S, n=30) and control group (Group C, n=30). The patients in Group C were treated with standard therapy, while the patients in Group S were treated with goal-directed fluid therapy. The Kidney Disease: Improving Global Outcomes (KDIGO) classification and renal biomarkers were used for the evaluation of acute kidney injury.

Results: Acute kidney injury rates were similar in both groups (30%). Postoperative fluid requirement, intra-, and postoperative erythrocyte suspension requirements were significantly lower in Group S than Group C (p=0.002, p=0.02, and p=0.002, respectively). Cystatin-C was lower in Group S (p<0.002). The kidney injury molecule-1, glomerular filtration rate, and creatinine levels were similar in both groups. The length of hospital stay was longer in Group C than Group S (p<0.001).

Conclusion: Although goal-directed fluid therapy does not change the incidence of acute kidney injury in patients undergoing cardiac surgery, it can significantly decrease Cystatin-C levels. Goal-directed fluid therapy can also decrease fluid and erythrocyte requirements with shorter length of hospital stay.

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Acute renal failure in critically ill patients: a multinational, multicenter study.

Shigehiko Uchino, John A. Kellum, Rinaldo Bellomo … (2005)

Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world. To determine the period prevalence of ARF in intensive care unit (ICU) patients in multiple countries; to characterize differences in etiology, illness severity, and clinical practice; and to determine the impact of these differences on patient outcomes. Prospective observational study of ICU patients who either were treated with renal replacement therapy (RRT) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries. Occurrence of ARF, factors contributing to etiology, illness severity, treatment, need for renal support after hospital discharge, and hospital mortality. Of 29 269 critically ill patients admitted during the study period, 1738 (5.7%; 95% confidence interval [CI], 5.5%-6.0%) had ARF during their ICU stay, including 1260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5%; 95% CI, 45.2%-49.5%). Approximately 30% of patients had preadmission renal dysfunction. Overall hospital mortality was 60.3% (95% CI, 58.0%-62.6%). Dialysis dependence at hospital discharge was 13.8% (95% CI, 11.2%-16.3%) for survivors. Independent risk factors for hospital mortality included use of vasopressors (odds ratio [OR], 1.95; 95% CI, 1.50-2.55; P<.001), mechanical ventilation (OR, 2.11; 95% CI, 1.58-2.82; P<.001), septic shock (OR, 1.36; 95% CI, 1.03-1.79; P = .03), cardiogenic shock (OR, 1.41; 95% CI, 1.05-1.90; P = .02), and hepatorenal syndrome (OR, 1.87; 95% CI, 1.07-3.28; P = .03). In this multinational study, the period prevalence of ARF requiring RRT in the ICU was between 5% and 6% and was associated with a high hospital mortality rate.

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A positive fluid balance is associated with a worse outcome in patients with acute renal failure

Didier Payen, Anne-Cornélie JM de Pont, Yasser Sakr … (2008)

Introduction Despite significant improvements in intensive care medicine, the prognosis of acute renal failure (ARF) remains poor, with mortality ranging from 40% to 65%. The aim of the present observational study was to analyze the influence of patient characteristics and fluid balance on the outcome of ARF in intensive care unit (ICU) patients. Methods The data were extracted from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a multicenter observational cohort study to which 198 ICUs from 24 European countries contributed. All adult patients admitted to a participating ICU between 1 and 15 May 2002, except those admitted for uncomplicated postoperative surveillance, were eligible for the study. For the purposes of this substudy, patients were divided into two groups according to whether they had ARF. The groups were compared with respect to patient characteristics, fluid balance, and outcome. Results Of the 3,147 patients included in the SOAP study, 1,120 (36%) had ARF at some point during their ICU stay. Sixty-day mortality rates were 36% in patients with ARF and 16% in patients without ARF (P < 0.01). Oliguric patients and patients treated with renal replacement therapy (RRT) had higher 60-day mortality rates than patients without oliguria or the need for RRT (41% versus 33% and 52% versus 32%, respectively; P < 0.01). Independent risk factors for 60-day mortality in the patients with ARF were age, Simplified Acute Physiology Score II (SAPS II), heart failure, liver cirrhosis, medical admission, mean fluid balance, and need for mechanical ventilation. Among patients treated with RRT, length of stay and mortality were lower when RRT was started early in the course of the ICU stay. Conclusion In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality. Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.

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Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery

Shay McGuinness, Rachael Parke, Jonathan Serpell … (2018)

Guidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, the supporting evidence is limited, and there is concern about impaired organ perfusion.

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Author and article information

Journal

Journal ID (nlm-ta): Turk Gogus Kalp Damar Cerrahisi Derg

Journal ID (iso-abbrev): Turk Gogus Kalp Damar Cerrahisi Derg

Title: Turkish Journal of Thoracic and Cardiovascular Surgery

Publisher: Bayçınar Medical Publishing

ISSN (Print): 1301-5680

ISSN (Electronic): 2149-8156

Publication date Collection: October 2023

Publication date (Electronic): 19 October 2023

Volume: 31

Issue: 4

Pages: 467-478

Affiliations

[1 ] Department of Anaesthesiology and Reanimation, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Türkiye

[2 ] Department of Cardiovascular Surgery, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Türkiye

[3 ] Department of Anaesthesiology and Reanimation, Manisa City Hospital, Manisa, Türkiye

[4 ] Department of Cardiology, Manisa City Hospital, Manisa, Türkiye

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İmge Özdemir, MD. imgekaratas@ 123456hotmail.com .

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İmge Özdemir http://orcid.org/0000-0003-1848-0252

Tülün Öztürk http://orcid.org/0000-0003-2865-5722

Dilşad Amanvermez http://orcid.org/0000-0002-3316-6707

Funda Yıldırım http://orcid.org/0000-0002-1577-0281

Arife Şengel http://orcid.org/0000-0003-2515-1174

İbrahim Halil Özdemir http://orcid.org/0000-0003-3953-4387

Article

DOI: 10.5606/tgkdc.dergisi.2023.24987

PMC ID: 10704525

PubMed ID: 38075986

SO-VID: 7c5b5df7-41a4-47c4-8693-adf6c7ab7aaa

License:

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

The effects of perioperative goal-directed therapy on acute kidney injury after cardiac surgery in the early period

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Karger: Nephrology

Most cited references 39

Acute renal failure in critically ill patients: a multinational, multicenter study.

A positive fluid balance is associated with a worse outcome in patients with acute renal failure

Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery

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