Intraoperative venous congestion and acute kidney injury in cardiac surgery: an observational cohort study.
Br J Anaesth
; 126(3): 599-607, 2021 Mar.
Article
in En
| MEDLINE
| ID: mdl-33549321
ABSTRACT
BACKGROUND:
Increased intravascular volume has been associated with protection from acute kidney injury (AKI), but in patients with congestive heart failure, venous congestion is associated with increased AKI. We tested the hypothesis that intraoperative venous congestion is associated with AKI after cardiac surgery.METHODS:
In patients enrolled in the Statin AKI Cardiac Surgery trial, venous congestion was quantified as the area under the curve (AUC) of central venous pressure (CVP) >12, 16, or 20 mm Hg during surgery (mm Hg min). AKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria and urine concentrations of tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ([TIMP-2]â [IGFBP7]), a marker of renal stress. We measured associations between venous congestion, AKI and [TIMP-2]â [IGFBP7], adjusted for potential confounders. Values are reported as median (25th-75th percentile).RESULTS:
Based on KDIGO criteria, 104 of 425 (24.5%) patients developed AKI. The venous congestion AUCs were 273 mm Hg min (81-567) for CVP >12 mm Hg, 66 mm Hg min (12-221) for CVP >16 mm Hg, and 11 mm Hg min (1-54) for CVP >20 mm Hg. A 60 mm Hg min increase above the median venous congestion AUC above each threshold was independently associated with increased AKI (odds ratio=1.06; 95% confidence interval [CI], 1.02-1.10; P=0.008; odds ratio=1.12; 95% CI, 1.02-1.23; P=0.013; and odds ratio=1.30; 95% CI, 1.06-1.59; P=0.012 for CVP>12, >16, and >20 mm Hg, respectively). Venous congestion before cardiopulmonary bypass was also associated with increased [TIMP-2]â [IGFBP7] measured during cardiopulmonary bypass and after surgery, but neither venous congestion after cardiopulmonary bypass nor venous congestion throughout surgery was associated with postoperative [TIMP-2]â [IGFBP7].CONCLUSION:
Intraoperative venous congestion was independently associated with increased AKI after cardiac surgery.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Central Venous Pressure
/
Acute Kidney Injury
/
Cardiac Surgical Procedures
/
Hyperemia
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Language:
En
Journal:
Br J Anaesth
Year:
2021
Document type:
Article