The risk of acute kidney injury with co-occurrence of anemia and hypotension during cardiopulmonary bypass relative to anemia alone

Robert Sickeler, Barbara Phillips-Bute, M. Kertai, Jacob Schroder, Joseph P. Mathew, Madhav Swaminathan, Mark Stafford-Smith

Research output: Contribution to journalArticle

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Abstract

Background Postoperative acute kidney injury (AKI) is a common serious consequence of cardiac surgery. One recent study found higher AKI rates when anemia and hypotension occurred during cardiopulmonary bypass (CPB) relative to anemia alone. To revalidate this post hoc observation we analyzed detailed data from a large cardiac surgery cohort. Methods Patient, procedural, and outcome data were collected for nonemergent aortocoronary bypass and valve surgeries between July 2001 and September 2012. The occurrence of AKI (as defined by the Acute Kidney Injury Network criteria) was analyzed relative to known renal risk factors, and CPB hematocrit and blood pressure determinations in univariate and multivariable linear regression analyses. Results In our 3,963-patient cohort, we did not observe different AKI rates with the co-occurrence of anemia and hypotension relative to anemia alone (41.6% versus 44.3%; p = 0.39). Secondary analyses using linear definitions for AKI, CPB anemia, and hypotensive burden, and assessing for coincident timing also did not demonstrate significant association of anemia and hypotension with AKI risk relative to anemia alone. Conclusions In a large cohort of cardiac surgery patients, we did not confirm any association of cardiac surgery-related AKI risk with the co-occurrence of hypotension and anemia during CPB relative to anemia alone. More detailed analyses also failed to support an anemia-hypotension interaction. Additional studies are required to better understand the relationship among anemia, hypotension during CPB, and postoperative AKI, but existing evidence is insufficient to support changes in clinical practice.

Original languageEnglish
Pages (from-to)865-871
Number of pages7
JournalAnnals of Thoracic Surgery
Volume97
Issue number3
DOIs
Publication statusPublished - Mar 2014

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Cardiopulmonary Bypass
Acute Kidney Injury
Hypotension
Anemia
Thoracic Surgery
Blood Pressure Determination
Hematocrit
Coronary Artery Bypass
Linear Models
Regression Analysis
Observation
Kidney

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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The risk of acute kidney injury with co-occurrence of anemia and hypotension during cardiopulmonary bypass relative to anemia alone. / Sickeler, Robert; Phillips-Bute, Barbara; Kertai, M.; Schroder, Jacob; Mathew, Joseph P.; Swaminathan, Madhav; Stafford-Smith, Mark.

In: Annals of Thoracic Surgery, Vol. 97, No. 3, 03.2014, p. 865-871.

Research output: Contribution to journalArticle

Sickeler, Robert ; Phillips-Bute, Barbara ; Kertai, M. ; Schroder, Jacob ; Mathew, Joseph P. ; Swaminathan, Madhav ; Stafford-Smith, Mark. / The risk of acute kidney injury with co-occurrence of anemia and hypotension during cardiopulmonary bypass relative to anemia alone. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 3. pp. 865-871.
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N2 - Background Postoperative acute kidney injury (AKI) is a common serious consequence of cardiac surgery. One recent study found higher AKI rates when anemia and hypotension occurred during cardiopulmonary bypass (CPB) relative to anemia alone. To revalidate this post hoc observation we analyzed detailed data from a large cardiac surgery cohort. Methods Patient, procedural, and outcome data were collected for nonemergent aortocoronary bypass and valve surgeries between July 2001 and September 2012. The occurrence of AKI (as defined by the Acute Kidney Injury Network criteria) was analyzed relative to known renal risk factors, and CPB hematocrit and blood pressure determinations in univariate and multivariable linear regression analyses. Results In our 3,963-patient cohort, we did not observe different AKI rates with the co-occurrence of anemia and hypotension relative to anemia alone (41.6% versus 44.3%; p = 0.39). Secondary analyses using linear definitions for AKI, CPB anemia, and hypotensive burden, and assessing for coincident timing also did not demonstrate significant association of anemia and hypotension with AKI risk relative to anemia alone. Conclusions In a large cohort of cardiac surgery patients, we did not confirm any association of cardiac surgery-related AKI risk with the co-occurrence of hypotension and anemia during CPB relative to anemia alone. More detailed analyses also failed to support an anemia-hypotension interaction. Additional studies are required to better understand the relationship among anemia, hypotension during CPB, and postoperative AKI, but existing evidence is insufficient to support changes in clinical practice.

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