Effectiveness of Continuous Renal Replacement Therapy of Acute Kidney Injury after Type A Aortic Dissection Surgery: A Case Control Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

Department of Cardiovascular Surgery, Affiliated Union Hospital of Fujian Medical University, Fuzhou 350004, P. R. China;

Corresponding author：

Keywords：

Continuous renal replacement therapy; Bedside intermittent hemodialysis; Type A aortic dissection; Acute kidney injury

DOI：

10.7507/1007-4848.20160002

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Objective To evaluate the efficacy of the continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) after the surgery of type A aortic dissection. Methods We retrospectively analyzed 58 hemodialysis patients with AKI after type A aortic dissection surgery in our hospital between January 2003 and January 2014.The 58 patients were divided into two groups including a bedside intermittent hemodialysis (IHD) group and a CRRT group based on the methods of hemodialysis. There were 38 patients with 29 males and 9 females at average age of 49.8± 13.7 years in the CRRT group. There were 20 patients in the IHD group with 14 males and 6 females at average age of 52.6± 11.0 years. Results Compared with IHD, CRRT had significantly greater effect on reducing the simplified acute physiology scoring system (SAPS)Ⅱscore (F_time=60.964, P=0.000; F_time _{* group}=3.178, P=0.041). However, there was no significant difference in reducing the acute tubular necrosis individual illness severity index (ATN-ISI) score between the two groups (F_time=13.803, P=0.000; F_time _{* group}=0.222, P=0.951). Lower incidences of dialysis-related complications including hypotension (P=0.027) and acute congestive heart failure (P=0.011) were found in the CRRT group. There was no statistical difference in operation time (P=0.367) between the two groups. While statistical differences in duration of hospitalization in intensive care unit (P=0.006), in hospital time (P=0.047), frequency of dialysis (P=0.001), and dialysis time (P=0.039) were found between the two groups. However there were no significant differences in mortality during hospital (P=0.544)and incidences of recovery (P=0.056) between the two groups. Conclusion Compared with IHD, CRRT had significantly positive effect on patients who suffered from AKI after type A aortic dissection surgery, which can help reduce incidences of dialysis-related complications, duration and cost of hospitalization in ICU.

Citation： LINYong, CHENLiang-wan, CAOHua, CHENMei-fang. Effectiveness of Continuous Renal Replacement Therapy of Acute Kidney Injury after Type A Aortic Dissection Surgery: A Case Control Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(1): 7-11. doi: 10.7507/1007-4848.20160002 Copy

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2.	Baumann F, Makaloski V, Diehm N. Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics. Internist (Berl), 2013, 54(5): 535-542.
3.	Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94: 766-771.
4.	Kolli H, Rajagopalam S, Patel N, et al. Mild acute kidney injury is associated with increased mortality after cardiac surgery in patients with eGFR < 60 mL/min/1. 73 m(2). Ren Fail, 2010, 32(9): 1066-1072.
5.	Kellum JA, Mehta RL, Angus DC, et al. The first international consensus conference on continuous renal replacement therapy. Kidney Int, 2002, 62(5): 1855-1863.
6.	Mehta RL. Indications for dialysis in the ICU: renal replacement vs. renal support. Blood Purif, 2001, 19(2): 227-232.
7.	Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clin Pract, 2012, 120(4): 179-184.
8.	Liañ o F, Gallego A, Pascual J, et al. Prognosis of acute tubular necrosis: an extended prospectively contrasted study. Nephron, 1993, 63(1): 21-31.
9.	Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPSⅡ) based on a European/North American multicenter study. JAMA, 1993, 270(24): 2957-2963.
10.	Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth, 2012, 109( Suppl 1): i29-38.
11.	Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.
12.	Mariscalco G, Lorusso R, Dominici C, et al. Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg, 2011, 92(4): 1539-1547.
13.	Douthitt L, Bezinover D, Uemura T, et al. Perioperative use of contin-uous renal replacement therapy for orthotopic liver transplantation. Transplant Proc, 2012, 44: 1314-1317.
14.	Abe R, Oda S, Shinozaki K, et al. Continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter for severe acute pancreatitis. Contrib Nephrol, 2010, 166: 54-63.
15.	Liu EB, Niu XQ, Song YL, et al. Effect of continuous hemofiltration on inflammatory mediator in multi-organ dysfunction syndrome patients. Appl J General Pract, 2007, 5: 43-44.
16.	Wald R, Shariff SZ, Adhikari NK, et al. The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study. Critic Care Med, 2014, 42: 868-877.
17.	Sablotzki A, Dehne MG, Friedrich I, et al. Different expression of cytokines in survivors and non-survivors from MODS following cardiovascular surgery. Eur J Med Res, 2003, 8(2): 71-76.

1. De Leó n Ayala IA, Chen YF. Acute aortic dissection: an update. Kaohsiung J Med Sci, 2012, 28(6): 299-305.
2. Baumann F, Makaloski V, Diehm N. Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics. Internist (Berl), 2013, 54(5): 535-542.
3. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94: 766-771.
4. Kolli H, Rajagopalam S, Patel N, et al. Mild acute kidney injury is associated with increased mortality after cardiac surgery in patients with eGFR < 60 mL/min/1. 73 m(2). Ren Fail, 2010, 32(9): 1066-1072.
5. Kellum JA, Mehta RL, Angus DC, et al. The first international consensus conference on continuous renal replacement therapy. Kidney Int, 2002, 62(5): 1855-1863.
6. Mehta RL. Indications for dialysis in the ICU: renal replacement vs. renal support. Blood Purif, 2001, 19(2): 227-232.
7. Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clin Pract, 2012, 120(4): 179-184.
8. Liañ o F, Gallego A, Pascual J, et al. Prognosis of acute tubular necrosis: an extended prospectively contrasted study. Nephron, 1993, 63(1): 21-31.
9. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPSⅡ) based on a European/North American multicenter study. JAMA, 1993, 270(24): 2957-2963.
10. Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth, 2012, 109( Suppl 1): i29-38.
11. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.
12. Mariscalco G, Lorusso R, Dominici C, et al. Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg, 2011, 92(4): 1539-1547.
13. Douthitt L, Bezinover D, Uemura T, et al. Perioperative use of contin-uous renal replacement therapy for orthotopic liver transplantation. Transplant Proc, 2012, 44: 1314-1317.
14. Abe R, Oda S, Shinozaki K, et al. Continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter for severe acute pancreatitis. Contrib Nephrol, 2010, 166: 54-63.
15. Liu EB, Niu XQ, Song YL, et al. Effect of continuous hemofiltration on inflammatory mediator in multi-organ dysfunction syndrome patients. Appl J General Pract, 2007, 5: 43-44.
16. Wald R, Shariff SZ, Adhikari NK, et al. The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study. Critic Care Med, 2014, 42: 868-877.
17. Sablotzki A, Dehne MG, Friedrich I, et al. Different expression of cytokines in survivors and non-survivors from MODS following cardiovascular surgery. Eur J Med Res, 2003, 8(2): 71-76.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effectiveness of Continuous Renal Replacement Therapy of Acute Kidney Injury after Type A Aortic Dissection Surgery: A Case Control Study

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