The risk factors and late outcomes of acute kidney injury in patients after heart valve replacement with cardiopulmonary bypass
Abstract
We studied the dynamics of changes in renal function in hospital and follow-up period in patients who underwent the heart valve replacement with cardiopulmonary bypass (CPB). The predictors of acute kidney injury (AKI) and hemodialysis requirement were revealed. 113 patients were enrolled into investigation. The long-term results were evaluated in 56 of them. We analyzed renal function with glomerular filtration rate (GFR) estimated with MDRD and Cockroft–Gault equation during first post-operative day, before the discharge from the hospital and in 1 year after surgery. There was a significant decrease in GFR from 90,0 ± 32,8 ml/min/1,73 m2 to 54,5 ± 22,9 ml/min/1,73 m2 in 24 hours after an operation with consequent restitution to 86,1 ± 38,1 ml/min/1,73 m2 (p < 0,001). According to “RIFLE” classification taking into consideration changes in the serum creatinine level 108 patients were divided into the following groups: no AKI – 40 (37%) patients, risk – 35 (32,4%) patients, injury – 26 (24,1%) patients, failure – 7 (6,5%) patients. The dialysis requirement occurred in 5 (4,4%) patients. Conclusion. The GFR decreases in 24 hours after heart valve replacement operation and restores at the end of the period of hospitalization. This dynamics was similar in patients with different heart valves diseases. The risk factors of AKI and dialysis requirement are initially low GFR, age of patients and the duration of CPB. In 1 year after heart surgery there were fewer patients with 1st stage of chronic renal disease, more of those with 2nd and 3rd stages, and the same fraction of patients who suffering from 4th stage of chronic renal disease. The patients who needed the dialysis during early post-operative period survived without this procedure in the follow-up period.
About the Authors
E. V. Plotnikova
E.E. Volosevich city clinical hospital No 1, Arkhangelsk
Russian Federation
Russian Federation
O. A. Mirolyubova
Northern State Medical University, Arkhangelsk
Russian Federation
Russian Federation
A. N. Shonbin
E.E. Volosevich city clinical hospital No 1, Arkhangelsk
Russian Federation
Russian Federation
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Review
For citations:
Plotnikova E.V., Mirolyubova O.A., Shonbin A.N. The risk factors and late outcomes of acute kidney injury in patients after heart valve replacement with cardiopulmonary bypass. Nephrology and Dialysis. 2011;13(2):096-100. (In Russ.)
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