Correlation of intraoperative renal near infrared spectroscopy with the development of acute kidney injury in adult patients undergoing cardiac surgery using cardiopulmonary bypass

Document Type: Original Article

Authors

1 Anaesthesiologist, Department of Anesthesia , Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai -400022, Maharashtra, India.

2 Cardiovascular & Thoracic surgeon Department of cardiovascular & thoracic surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai -400022, Maharashtra, India.

Abstract

Introduction: The present study aimed to correlate renal oximetry near-infrared spectroscopy (NIRS) values with conventional non-invasive biomarkers for the early detection of acute kidney injury (AKI) in adult patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Accordingly, renal NIRS can be employed as a trending device for the prevention of AKI development.
Materials and methods: After institutional ethical committee approval, a number of 132 adult patients undergoing cardiac surgery with CPB were selected by consecutive consenting sampling method. Emergency surgery and patients with preexistent renal insufficiency were excluded. NIRS sensor was applied on either the right or the left side of the spine at the lower border of L-1 before starting the induction. A renal regional oxygen saturation (rSO2) score was calculated after recording the renal oximetry values intra- and postoperatively. Urine output and serum creatinine were measured at 24, 48, and 72 hours postoperatively.
Results: Out of 132 patients, 22 cases (16.66 %) developed AKI according to Acute Kidney Injury Network (Akin) criteria± Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification. Among these AKI patients, three cases required dialysis, and one of these three patients died on the 21st day postsurgery. Renal rSO2 scores in the AKI group were measured at 535 and 912 minutes %, in comparison to 162 and 184 minutes % reported in the non-AKI group which was statistically significant (P< 0.05).
Conclusion: As evidenced by the obtained results, there is a correlation between intraoperatively measured renal NIRS readings and the occurrence of AKI following adult cardiac surgery using CPB.

Keywords


1. Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA. Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol Dial Transplant. 2008; 23:1970-4.

2. Yehia M, Collins JF, Beca J. Acute renal failure in patients with pre-existing renal dysfunction following coronary artery bypass grafting. Nephrology (Carlton). 2005; 10:541-3.

3. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med. 1998; 128:194-203.

4. Ostermann ME, Taube D, Morgan CJ, Evans TW. Acute renal failure following cardiopulmonary bypass: a changing picture. Intensive Care Med. 2000; 26:565-71.

5. Bahar I, Akgul A, Ozatik MA, Vural KM, Demirbag AE, Boran M, et al. Acute renal failure following open heart surgery: risk factors and prognosis. Perfusion. 2005; 20:317-22.

6- Landoni G, Zangrillo A, Franco A, Aletti G, Roberti A, Calabro MG, et al. Long-term outcome of patients who require renal replacement therapy after cardiac surgery. Eur J Anaesthesiol. 2006; 23:17-22.

7. Bove T, Monaco F, Covello RD, Zangrillo A. Acute renal failure and cardiac surgery. HSR Proc Intensive Care Cardiovasc Anesth. 2009; 1:13-21.

8. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve

 

Outcomes in acute kidney injury. Crit Care. 2007; 11:R31.

9. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004; 8:R204-12.

10. Smith MN, Best D, Sheppard SV, Smith DC. The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction. Anaesthesia. 2008; 63:701-4.

11. Long DM, Jenkins E, Griffith K. Perfusionist techniques of reducing acute kidney injury following cardiopulmonary bypass : an evidence-based review. Perfusion. 2015; 30:25-32.

12. Ruf B, Bonelli V, Balling G, Hörer J, Nagdyman N, Braun SL, et al. Intraoperative renal near infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass- a case control study. Crit Care. 2015; 19:27.

13. Berens RJ, Stuth EA, Robertson FA, Jaquiss RD, Hoffman GM, Cava JR, et al. Near infrared spectroscopy monitoring during pediatric aortic coarctation repair. Pediatric Anesthesia. 2006; 16:777-81.

14. Fenton KN, Freeman K, Glogowski K, Fogg S, Duncan KF. The significance of baseline cerebral oxygen saturation in children undergoing congenital heart surgery. Am J Surg. 2005; 190:260-3