Analysis Of Risk Factors Related To Acute Renal Injury After Off-pump Coronary Artery Bypass Grafting

Objective To investigate the risk factors of acute renal dysfunction(AKI)after off-pump coronary artery bypass(OPCAB)Methods A retrospective analysis of clinical feature,early changes of renal function and prognosis was performed in 1260 cases of patients from January 2010 to March 2017 underwent OPCAB surgery according to the standard evaluation of early renal damage after operation,which was made by the Kidney Disease:Improving Global Outcomes(KDIGO)2012.264 cases(20.9%)with AKI were selected as the observation group while 996 patients without AKI were set as the control group.Risk factors of AKI between the two groups were analyzed by univariate and multivariate logistic regression.Results The observation group was divided into three stages according to the severity of AKI,which contain 210 cases in Stage 1(79.5%),37 cases in Stage 2(14.0%),17 cases in Stage 3(6.4%).There were 19 cases with early postoperative deaths or automatic discharge in total 1260 cases(1.5%),6 cases in the control group of 996 cases and 13 cases in the observation group of 264 cases,in which 4 cases were staged as stage 1,2 cases staged as stage 2 and 7 cases staged as stage 3.All the seven stage 3 cases with early postoperative deaths or automatic discharge in the control group needed continuous renal replacement therapy.Univariate analysis showed that risk factors of OPCAB related AKI include old age,high body mass index(BMI),hypertension,poor controlled blood pressure,poor controlled blood glucose,pulmonary function with moderate or severe loss,recent acute myocardial infarction,preoperative renal dysfunction,high level of serum creatinine,cardiac insufficiency,coronary angiography(CAG)within 72 hours,intraoperative hypotension,long time hypotension after surgery,acidosis,hyperlactacidemia,postoperative hypoxemia or respiratory failure,blood transfusion,postoperative fever,long time use of respirator,intra-aortic balloon counterpulsation(IABP),the use of continuous renal replacement therapy(continuous renal replacement therapy,CRRT).Multivariate logistic regression analysis showed that the incidence of AKI was higher in patients with high BMI,history of hypertension,recent myocardial infarction,mean arterial pressure in operation,and postoperative lactic acidosisConclusion:AKI after OPCAB was associated with various factors,and AKI will result in a significant increase in early postoperative mortality and automatic discharge,especially severe AKI requires patients receiving renal replacement therapy.