Determinants of 28-day mortality in patients with aсute kidney injury following cardiac surgery

Objective: to identify the important determinants of the 28-day mortality and to assess their explanatory power in adult patients in undergoing continuous renal replacement therapy (CRRT) for cardiac surgery-associated acute kidney injury AKI (CS-AKI). Material and methods: the retrospective cohort monocenter study covered 162 cardiac surgical patients over 18 years old operated under cardio-pulmonary bypass (CPB) and complicated by the development of AKI treated with CRRT. Study endpoints were 28-day and hospital mortality. Results: it was found that the most important determinants of 28-day mortality in patients undergoing cardiac surgery with the development AKI were the use of extracorporeal membrane oxygenation (ECMO), the duration of days with oliguria and the used intra-aortic balloon pumping (Odd Ratio 7.24; 6.55; 3.75; respectively). It was found that the ratio of the surface area of the haemofilter membrane to the body surface area as a significant determinant of mortality in cardiac patients with AKI (Odd Ratio 1.41). We found that the CRRT dose effluent is not associated with the 28-day mortality. Whereas, the maximum level of lactate during the CRRT had a good explanatory power (AUC 0.79) with sensitivity and specificity of 0.9/0.71. Daily fluid balance and the total balance of body fluids (delta) during CRRT verified as suitable determinants in predicting the 28-day mortality (AUC 0.784, AUC 0.786, respectively). Conclusion: in patients with severe CS-AKI requiring CRRT, 28-day mortality appears strongly associated with extrarenal (cardiovascular) factors, which determine the short-term outcomes. The ratio of surface area of haemofilter membrane/body surface area provided to be a factor modifying short-term mortality in patients with AKI.

продолженная заместительная почечная терапия, детерминанты, острое повреждение почек, послеоперационный период, кардиохирургия, continuous renal replacement therapy, determinants, acute kidney injury, postoperative period, cardiac surgery

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