Comparison of Diagnostic Criteria for Acute Kidney Injury in Cardiac
Surgery |
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Authors: | Márcio Campos Sampaio Carlos Alberto Gon?alves Máximo Carolina Moreira Montenegro Diandro Marinho Mota Tatiana Rocha Fernandes Antonio Carlos Mugayar Bianco Celso Amodeo Antonio Carlos Cordeiro |
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Institution: | 1. Dante Pazzanese Institute of Cardiology - Department of Hypertension and Nephrology, São Paulo, SP - Brazil ;2. Dante Pazzanese Institute of Cardiology - Intensive Care Unit, São Paulo, SP - Brazil |
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Abstract: | BackgroundThere is considerable controversy regarding the diagnosis of Acute Kidney Injury
(AKI), and there are over 30 different definitions. ObjectiveTo evaluate the incidence and risk factors for the development of AKI following
cardiac surgery according to the RIFLE, AKIN and KDIGO criteria, and compare the
prognostic power of these criteria. MethodsCross-sectional study that included 321 consecutive patients (median age 62
53-71] years; 140 men) undergoing cardiac surgery between June 2011 and January
2012. The patients were followed for up to 30 days, for a composite outcome
(mortality, need for dialysis and extended hospitalization). ResultsThe incidence of AKI ranged from 15% - 51%, accordingly to the diagnostic
criterion adopted. While age was associated with risk of AKI in the three
criteria, there were variations in the remaining risk factors. During follow-up,
89 patients developed the outcome and all criteria were associated with increased
risk in the univariate Cox analysis and after adjustment for age, gender,
diabetes, and type of surgery. However, after further adjustment for
extracorporeal circulation and the presence of low cardiac output, only AKI
diagnosed by the KDIGO criterion maintained this significant association (HR= 1.89
95% CI: 1.18 - 3.06]). ConclusionThe incidence and risk factors for AKI after cardiac surgery vary significantly
according to the diagnostic criteria used. In our analysis, the KDIGO criterion
was superior to AKIN and RIFLE with regard its prognostic power. |
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Keywords: | Acute kidney failure Cardiac Surgery Hemodialysis Coronary Artery Bypass |
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