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Early postoperative change in serum creatinine predicts acute kidney injury after cardiothoracic surgery: a retrospective cohort study

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Abstract

Background

Acute kidney injury (AKI) is one of the most severe complications after cardiothoracic surgery (CTS). However, diagnosis of AKI by elevation of serum creatinine (SCr) misses a critical time period for prevention and treatment of AKI. We have observed that patients who develop AKI show a smaller SCr decrease after CTS than those without AKI. Hence, we hypothesized that the magnitude of the SCr change (ΔSCr) measured early after CTS can predict subsequent AKI.

Methods

We conducted a retrospective analysis from January 2014 to December 2016 to examine the association of ΔSCr with AKI. ΔSCr was calculated as follows: (early postoperative SCr on intensive care unit [ICU] admission) − (preoperative SCr). Established risk factors and demographics were included in the multivariate-adjusted logistic regression model. AKI was defined by SCr criteria of the Kidney Disease: Improving Global Outcomes group.

Results

Among 252 patients who underwent CTS, 69 developed AKI. The median ΔSCr was − 0.14 mg/dL (range − 0.96–0.45). Patients were divided into three groups based on ΔSCr: Group 1, ≤ − 0.2 mg/dL (n = 84); Group 2, > − 0.2 to < − 0.1 mg/dL (n = 76); and Group 3, ≥ − 0.1 mg/dL (n = 92). In the multivariate analysis, Group 3 had a significantly higher incidence of AKI than Group 1 (odds ratio, 7.34; 95% confidence interval 2.55–23.3). ΔSCr was an independent risk factor for AKI (odds ratio for every 0.1-mg/dL increase in ΔSCr, 1.55; 95% confidence interval 1.23–1.97).

Conclusions

A minor change in the SCr level early after CTS can predict subsequent AKI just after ICU admission.

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Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (http://www.edanzediting.com/ac), for editing a draft of this manuscript. We also thank all of the medical staff members of the Department of Cardiothoracic and Vascular Surgery for their contributions to the database.

Funding

None.

Author information

Authors and Affiliations

  1. Division of Kidney Center, Matsuyama Red Cross Hospital, Ehime, Japan

    Hideaki Oka, Taro Kamimura & Atsumi Harada

  2. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Hideaki Oka, Shunsuke Yamada, Toshiaki Nakano & Takanari Kitazono

  3. Department of Nephrology, Nara Medical University, Nara, Japan

    Kazuhiko Tsuruya

Authors
  1. Hideaki Oka
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  2. Shunsuke Yamada
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  3. Taro Kamimura
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  4. Atsumi Harada
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  5. Kazuhiko Tsuruya
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  6. Toshiaki Nakano
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  7. Takanari Kitazono
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Corresponding author

Correspondence to Toshiaki Nakano.

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Conflict of interest

All the authors have declared no competing interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (local ethics committee of Matsuyama Red Cross Hospital (No. 582); (UMIN clinical trial registry No. UMIN000025889)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study waived the requirement for written informed consent due to the retrospective nature of this study. Rather, the research content has been included on the web page of our hospital (http://www.matsuyama.jrc.or.jp/rinsyo-kenkyu/).

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Oka, H., Yamada, S., Kamimura, T. et al. Early postoperative change in serum creatinine predicts acute kidney injury after cardiothoracic surgery: a retrospective cohort study. Clin Exp Nephrol 23, 325–334 (2019). https://doi.org/10.1007/s10157-018-1638-3

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  • DOI: https://doi.org/10.1007/s10157-018-1638-3

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