Risk Factors of Death in Patients Undergoing Continuous Renal Replacement Therapy after Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGHai ¹ , PANYan ² ,  YANGMin ¹ ,  SHENTuYang ³

1. Intensive Care Unit, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, P. R. China;
2. Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, P. R. China;
3. Department of Thoracic Surgery, Shanghai Chest Hospital/Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, P. R. China;

Corresponding author：

YANGMin, Email: yangmin1996@126.com; SHENTuYang, Email: yang_shentu@163.com

Keywords：

Cardiac surgery; Acute kidney injury; Continuous renal replacement therapy; Risk factor

DOI：

10.7507/1007-4848.20150211

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Objective To investigate the risk factors of death in patients undergoing continuous renal replacement therapy (CRRT) after cardiac surgery. Methods We retrospectively analyzed records of 66 adult patients without history of chronic renal failure suffering acute kidney injury (AKI) following cardiac surgery and undergoing CRRT in our hospital between July 2007 and June 2014. There were 38 males and 28 females with mean age of 59.11±12.62 years. They were divided into a survival group and a non-survival group according to prognosis at discharge. All perioperative data were collected and analyzed by univariate analysis and multivariate logistic regression analysis. Results In sixty-six adult patients, eighteen patients survived with a mortality rate of 72.7%. Through univariate analysis and multivariate logistic regression, risk factors of death in the post-operative AKI patients requiring CRRT included hypotension on postoperative day 1 (B=2.897, OR=18.127, P=0.001), duration of oliguria until hemofiltration (B=0.168, OR=1.183, P=0.024), and blood platelet on postoperative day 1 (B=-0.026, OR=0.974, P=0.001). Conclusion Hypotension on postoperative day 1 (POD1) is the predominant risk factor of death in patients requiring CRRT after cardiac surgery, while blood platelet on POD1 is a protective factor. If CRRT is required, the sooner the better.

Citation： ZHANGHai, PANYan, YANGMin, SHENTuYang. Risk Factors of Death in Patients Undergoing Continuous Renal Replacement Therapy after Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(9): 846-850. doi: 10.7507/1007-4848.20150211 Copy

1.	Mao H, Katz N, Ariyanon W, et al. Cardiac surgery-associated acute kidney injury. Cardiorenal Med, 2013, 3(3):178-199.
2.	Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol, 2006, 1(1):19-32.
3.	王旭冬,车妙琳,谢波,等. 急性肾损伤定义及分期系统评估心脏手术患者预后的临床价值. 中国胸心血管外科临床杂志, 2012, 19(6):619-623.
4.	Cosentino F, Chaff C, Piedmonte M. Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant, 1994, 9(Suppl 4):179-182.
5.	Lecomte P, Van Vlem B, Coddens J, et al. Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients. Crit Care, 2008, 12(6):R154.
6.	Hauer D, Kilger E, Kaufmann I, et al. Risk and outcome analysis of renal replacement therapies in patients after cardiac surgery with pre-operatively normal renal function. Anaesthesia, 2009, 64(6):615-619.
7.	Allen LA, Felker GM, Pocock S, et al. Liver function abnormalities and outcome in patients with chronic heart failure:data from the Candesartan in Heart Failure:Assessment of Reduction in Mortality and Morbidity(CHARM) program. Eur J Heart Fail, 2009, 11(2):170-177.
8.	Bapat V, Sabetai M, Roxburgh J, et al. Early and intensive continuous veno-venous hemofiltration for acute renal failure after cardiac surgery. Interact Cardiovasc Thorac Surg, 2004, 3(3):426-430.
9.	Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology, 2011, 114(4):964-970.
10.	丁文军, 刘华, 季强, 等. 心脏术后急性肾损伤行连续性静脉-静脉血液透析治疗失败的危险因素分析. 中华医学杂志, 2013, 93(22):1737-1739.
11.	Ji Q, Mei Y, Wang X, et al. Risk factors for failure of continuous veno-venous hemodialysis in the treatment of acute renal failure following cardiac surgery. Perfusion, 2010, 25(5):337-342.
12.	Despotis GJ, Avidan MS, Hogue CW Jr. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg, 2001, 72(5):S1821-1831.
13.	Ng RR, Chew ST, Liu W, et al. Identification of modifiable risk factors for acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Thorac Cardiovasc Surg, 2014, 147(4):1356-1361.
14.	王常田, 李德闽, 申翼, 等. 心血管手术后血小板的动态变化及其与患者预后的相关性分析. 解放军医学杂志, 2010, 35(9):1145-1147.
15.	张丽琴, 邢昌赢, 林花, 等. 重症急性肾损伤患者经连续性肾脏替代治疗后肾功能恢复的影响因素. 现代生物医学进展, 2014, 14(8):1490-1493.
16.	Bellomo R, Auriemma S, Fabbri A, et al. The pathophysiology of cardiac surgery-associated acute kidney injury(CSA-AKI). Int J Artif Organs, 2008, 31(2):166-178.
17.	Carrel T, Englberger L, Mohacsi P, et al. Low systemic vascular resistance after cardiopulmonary bypass:incidence, etiology, and clinical importance. J Card Surg, 2000, 15(5):347-353.
18.	Fischer GW, Levin MA. Vasoplegia during cardiac surgery:current concepts and management. Semin Thorac Cardiovasc Surg, 2010, 22(2):140-144.
19.	Suen WS, Mok CK, Chiu SW, et al. Risk factors for development of acute renal failure(ARF) requiring dialysis in patients undergoing cardiac surgery. Angiology, 1998, 49(10):789-800.
20.	徐静, 沈平雁, 马晓波, 等. CRRT 患者的 APACHE 评分及危险因素分析. 中国血液净化, 2010, 9(7):368-371.

1. Mao H, Katz N, Ariyanon W, et al. Cardiac surgery-associated acute kidney injury. Cardiorenal Med, 2013, 3(3):178-199.
2. Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol, 2006, 1(1):19-32.
3. 王旭冬,车妙琳,谢波,等. 急性肾损伤定义及分期系统评估心脏手术患者预后的临床价值. 中国胸心血管外科临床杂志, 2012, 19(6):619-623.
4. Cosentino F, Chaff C, Piedmonte M. Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant, 1994, 9(Suppl 4):179-182.
5. Lecomte P, Van Vlem B, Coddens J, et al. Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients. Crit Care, 2008, 12(6):R154.
6. Hauer D, Kilger E, Kaufmann I, et al. Risk and outcome analysis of renal replacement therapies in patients after cardiac surgery with pre-operatively normal renal function. Anaesthesia, 2009, 64(6):615-619.
7. Allen LA, Felker GM, Pocock S, et al. Liver function abnormalities and outcome in patients with chronic heart failure:data from the Candesartan in Heart Failure:Assessment of Reduction in Mortality and Morbidity(CHARM) program. Eur J Heart Fail, 2009, 11(2):170-177.
8. Bapat V, Sabetai M, Roxburgh J, et al. Early and intensive continuous veno-venous hemofiltration for acute renal failure after cardiac surgery. Interact Cardiovasc Thorac Surg, 2004, 3(3):426-430.
9. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology, 2011, 114(4):964-970.
10. 丁文军, 刘华, 季强, 等. 心脏术后急性肾损伤行连续性静脉-静脉血液透析治疗失败的危险因素分析. 中华医学杂志, 2013, 93(22):1737-1739.
11. Ji Q, Mei Y, Wang X, et al. Risk factors for failure of continuous veno-venous hemodialysis in the treatment of acute renal failure following cardiac surgery. Perfusion, 2010, 25(5):337-342.
12. Despotis GJ, Avidan MS, Hogue CW Jr. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg, 2001, 72(5):S1821-1831.
13. Ng RR, Chew ST, Liu W, et al. Identification of modifiable risk factors for acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Thorac Cardiovasc Surg, 2014, 147(4):1356-1361.
14. 王常田, 李德闽, 申翼, 等. 心血管手术后血小板的动态变化及其与患者预后的相关性分析. 解放军医学杂志, 2010, 35(9):1145-1147.
15. 张丽琴, 邢昌赢, 林花, 等. 重症急性肾损伤患者经连续性肾脏替代治疗后肾功能恢复的影响因素. 现代生物医学进展, 2014, 14(8):1490-1493.
16. Bellomo R, Auriemma S, Fabbri A, et al. The pathophysiology of cardiac surgery-associated acute kidney injury(CSA-AKI). Int J Artif Organs, 2008, 31(2):166-178.
17. Carrel T, Englberger L, Mohacsi P, et al. Low systemic vascular resistance after cardiopulmonary bypass:incidence, etiology, and clinical importance. J Card Surg, 2000, 15(5):347-353.
18. Fischer GW, Levin MA. Vasoplegia during cardiac surgery:current concepts and management. Semin Thorac Cardiovasc Surg, 2010, 22(2):140-144.
19. Suen WS, Mok CK, Chiu SW, et al. Risk factors for development of acute renal failure(ARF) requiring dialysis in patients undergoing cardiac surgery. Angiology, 1998, 49(10):789-800.
20. 徐静, 沈平雁, 马晓波, 等. CRRT 患者的 APACHE 评分及危险因素分析. 中国血液净化, 2010, 9(7):368-371.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Factors of Death in Patients Undergoing Continuous Renal Replacement Therapy after Cardiac Surgery

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