AUTHOR=Molina Andújar Alícia , Escudero Victor Joaquin , Piñeiro Gaston J. , Lucas Alvaro , Rovira Irene , Matute Purificación , Ibañez Cristina , Blasco Miquel , Quintana Luis F. , Sandoval Elena , Sánchez Marina Chorda , Quintana Eduard , Poch Esteban TITLE=Impact of cardiac surgery associated acute kidney injury on 1-year major adverse kidney events JOURNAL=Frontiers in Nephrology VOLUME=3 YEAR=2023 URL=https://www.frontiersin.org/journals/nephrology/articles/10.3389/fneph.2023.1059668 DOI=10.3389/fneph.2023.1059668 ISSN=2813-0626 ABSTRACT=Background

The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events (MAKE) [25% or greater decline in estimated glomerular filtration rate (eGFR), new hemodialysis, and death] after cardiac surgery in a Spanish cohort and to evaluate the utility of the score developed by Legouis D et al. (CSA-CKD score) in predicting the occurrence of MAKE.

Methods

This was a single-center retrospective study of patients who required cardiac surgery with cardiopulmonary bypass (CPB) during 2015, with a 1-year follow-up after the intervention. The inclusion criteria were patients over 18 years old who had undergone cardiac surgery [i.e., valve substitution (VS), coronary artery bypass graft (CABG), or a combination of both procedures].

Results

The number of patients with CKD (eGFR < 60 mL/min) increased from 74 (18.3%) to 97 (24%) within 1 year after surgery. The median eGFR declined from 85 to 82 mL/min in the non-CSA-AKI patient group and from 73 to 65 mL/min in those with CSA-AKI (p = 0.024). Fifty-eight patients (1.4%) presented with MAKE at the 1-year follow-up. Multivariate logistic regression analysis showed that the only variable associated with MAKE was CSA-AKI [odds ratio (OR) 2.386 (1.31–4.35), p = 0.004]. The median CSA-CKD score was higher in the MAKE cohort [3 (2–4) vs. 2 (1–3), p < 0.001], but discrimination was poor, with a receiver operating characteristic curve (AUC) value of 0.682 (0.611–0.754).

Conclusion

Any-stage CSA-AKI is associated with a risk of MAKE after 1 year. Further research into new measures that identify at-risk patients is needed so that appropriate patient follow-up can be carried out.