Risk Factors For Progression From Acute Kidney Injury After Cardiopulmonary Bypass To Chronic Kidney Disease

Background:Cardiopulmonary bypass(CPB)is currently an indispensable technical tool for direct cardiac surgery.However,CPB can cause systemic inflammatory response syndrome(SIRS),which causes different degrees of damage to various organs after surgery.Acute kidney injury(AKI)is a serious complication associated with increased hospital costs,longer hospital stays,and increased mortality.AKI is also an independent risk factor for chronic kidney disease(CKD)and end stage renal disease(ESRD).Currently,the progression of AKI is still judged based on blood creatinine and urine output,and early prediction of AKI progression and chronicity is a key link to reduce the number of patients entering ESRD or dying.Actively exploring more effective clinical predictors can help cardiovascular surgeons to identify high-risk patients after extracorporeal circulation in a timely manner,take early measures to protect the kidney,avoid the continued progression of AKI,and improve the clinical prognosis of patients after cardiac surgery.Objectives:In this study,we established a prospective cohort of a large sample of post-operative AKI after CPB to investigate the major risk factors associated with the occurrence and poor prognosis of AKI,as well as clinical risk factors for progression to CKD after extracorporeal circulation AKI,and to develop a preliminary stable risk prediction model for use by clinicians for early monitoring and intervention in high-risk populations.Content and methods:This was a prospective cohort study of patients who underwent CPB in the Department of Cardiovascular Surgery at Southern Hospital from May 2017 to April 2021 and who developed AKI postoperatively.Demographic data,medical history,medication use before admission and during hospitalization,routine laboratory indices during hospitalization,surgical modality and perioperative data were collected from patients.Risk factors for progression of AKI to CKD after CPB were analyzed using the KDIGO 2012 AKI diagnostic criteria.The endpoint was set as the development of CKD(eGFR<60 ml/min/1.73 m2)3 months after the onset of AKI,or the need for long-term renal replacement therapy or renal transplantation.The blood creatinine values of surviving patients with AKI after extracorporeal circulation were followed up regularly 3 months after hospital discharge.The experimental data were analyzed and processed using SPSS26.0 statistical analysis software,and the two-sided P<0.05 was considered statistically significant,and a multifactorial clinical risk model was constructed by logistic regression model;the subject working characteristic curve(ROC)was plotted,and the area under the curve(AUC)of the clinical model predicting AKI progression to CKD was analyzed.Results:1.A total of 253 patients with AKI after extracorporeal circulation were included,including 79(31.2%)in the AKI progression group and 174(68.8%)in the AKI non-progression group.2.Systolic blood pressure,mean arterial pressure,baseline blood creatinine,baseline glomerular filtration rate,emergency surgery,hypertension,use of calcium channel blockers,glucocorticoids during hospitalization,dialysis treatment,erythrocyte pressure product,blood calcium blood glucose,uric acid,intraoperative use of red blood cells,plasma,platelets,duration of extracorporeal circulation,preoperative white blood cell count,1h postoperative hemoglobin,platelet count(1day postoperative,2day postoperative),albumin(1day postoperative),blood creatinine(preoperative,1h postoperative,lday,2day,3day,7day),cystatin C(preoperative,1h postoperative,1day,2day,3day),blood creatinine at discharge,and length of stay all suggested a possible association with CPB-AKI progression to CKD,3.In the multifactorial logistic regression model,age(OR=1.054,95%CI:1.021-1.088,P=0.001),postoperative AKI classification(OR=4.765,95%CI;2.363-9.609,P<0,001),performed deep hypothermic arrest circulation(OR=4.209,95%CI:1.866-9.494,P=0.001),and ICU stay(OR=1.105,95%CI:1.027-1.190,P=0.008)were independent predictors of CPB-AKI progression to CKD.4.This study The area under the curve(AUC)of the multifactorial clinical risk prediction model developed to predict the progression of CPB-AKI to CKD was 0.826(P<0.001).Conclusion:Age,postoperative AKI staging,performing deep hypothermic circulation arrest,and ICU stay were independent predictors of CPB-AKI progression to CKD in the clinical model predicting CPB-AKI progression to CKD.And their predictive ability is good.Clinicians can screen high-risk patients based on these clinical indicators and intervene early to improve their prognosis.