Acute Kidney Injury After Cardiac Surgery Academic Article uri icon

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  • BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is a major health issue. Lacking effective therapies, risk factor modification may offer a means of preventing this complication. The objective of the present study was to identify and determine the prognostic importance of such risk factors. METHODS AND RESULTS: Data from a multicenter cohort of 3500 adult patients who underwent cardiac surgery at 7 hospitals during 2004 were analyzed (using multivariable logistic regression modeling) to determine the independent relationships between 3 thresholds of AKI (>25%, >50%, and >75% decrease in estimated glomerular filtration rate within 1 week of surgery or need for postoperative dialysis) with death rates, as well as to identify modifiable risk factors for AKI. The 3 thresholds of AKI occurred in 24% (n=829), 7% (n=228), and 3% (n=119) of the cohort, respectively. All 3 thresholds were independently associated with a >4-fold increase in the odds of death and could be predicted with several perioperative variables, including preoperative intra-aortic balloon pump use, urgent surgery, and prolonged cardiopulmonary bypass. In particular, 3 potentially modifiable variables were also independently and strongly associated with AKI. These were preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration. CONCLUSIONS: AKI after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication.


  • Karkouti, Keyvan
  • Wijeysundera, Duminda N
  • Yau, Terrence M
  • Callum, Jeannie L
  • Cheng, Davy C
  • Crowther, Mark
  • Dupuis, Jean-Yves
  • Fremes, Stephen E
  • Kent, Blaine
  • Laflamme, Claude
  • Lamy, Andre
  • Legare, Jean-Francois
  • Mazer, C David
  • McCluskey, Stuart A
  • Rubens, Fraser D
  • Sawchuk, Corey
  • Beattie, W Scott

publication date

  • February 3, 2009

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