Frequency of Acute Kidney Injury in Patients Treated With Normal Saline after Off-Pump Coronary Artery Bypass Grafting

Document Type: Original Article

Authors

1 Anesthesiologist, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 General Practitioner, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Anesthesiologist, Department of Anesthesiology, Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Community Medicine, Imam Reza Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Cardiac Surgeon, Department of Cardiac Surgery, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Acute kidney injury (AKI) is a common postoperative complication of cardiac surgery, which is associated with an increased risk of morbidity and mortality. This study investigated the frequency of postoperative AKI in low risk adult patients undergoing off-pump coronary artery bypass grafting (CABG).
Materials & Methods: All consecutive adult patients of American Society of Anesthesiologists (ASA) class II and III, who were transferred to the post-operative cardiac surgery ICU after off-pump CABG and were low risk for AKI from October 2013 to September 2014 at Emam Reza Hospital, Mashhad, Iran were enrolled in this prospective cohort study at a teaching hospital. The patients were explored for AKI development, based on risk-injury-failure-loss- end stage kidney disease (RIFLE) and acute kidney injury network (AKIN) criteria, frequency of metabolic acidosis, hypernatremia, hyperchloremia, and length of stay in ICU.
Results: According to the results of the present study, 479 patients with the mean age of 60.8±10.75 yrs were included. AKI occurred in 22 (4.4%) and23 (4.8%) patients, based on both the RIFLE and AKIN criteria, respectively with the highest rate of AKI, reported on the third and fourth post-operative days. Additionally, hyperchloremia and hypernatremia were observed in 71 (14.8%) and 76 (15.9%) patients, respectively. Only one case of mortality occurred during the study. Metabolic acidosis was reported in 112 (23.4%) patients with a high anion gap in 60 (12.5%) cases.
Conclusion: The current study demonstrated that hypernatremia and metabolic acidosis but not AKI are frequently seen in patients receiving normal saline following off pump CABG with low risk for AKI.

Keywords


  1. Serrano AB, Candela-Toha AM, Zamora J, Vera J, Muriel A, Del Rey JM, et al. Preoperative hydration with 0.9% normal saline to prevent acute kidney injury after major elective open abdominal surgery: a randomised controlled trial. Eur J Anaesthesiol. 2016; 33:436-43.
  2. Turner KR, Fisher EC, Hade EM, Houle TT, Rocco MV. The role of perioperative sodium bicarbonate infusion affecting renal function after cardiothoracic surgery. Front Pharmacol. 2014; 5:127.
  3. Cooper DS, Basu RK, Price JF, Goldstein SL, Krawczeski CD. The kidney in critical cardiac disease: proceedings from the 10th international conference of the pediatric cardiac intensive care society. World J Pediatr Congenit Heart Surg. 2016; 7:152-63.
  4. Yi Q, Li K, Jian Z, Xiao YB, Chen L, Zhang Y, et al. Risk factors for acute kidney injury after cardiovascular surgery: evidence from 2,157 cases and 49,777 controls- a meta-analysis. Cardiorenal Med. 2016; 6(3):237-50.
  5. Suen WS, Mok CK, Chiu SW, Cheung KL, Lee WT, Cheung D, et al. Risk factors for development of acute renal failure (ARF) requiring dialysis in patients undergoing cardiac surgery. Angiology. 1998; 49:789-800.
  6. Prough DS, Bidani A. Hyperchloremic metabolic acidosis is a predictable consequence of intraoper-ative infusion of 0.9% saline. Anesthesiology. 1999; 90:1247–9.
  7. Li H, Sun SR, Yap JQ, Chen JH, Qian Q. 0.9% saline is neither normal nor physiological. J Zhejiang Univ Sci B. 2016; 17(3):181-7.
  8. Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012; 308:1566-72.
  9. Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg. 2012; 2:821–9.
  10. Severs D, Rookmaaker MB, Hoorn EJ. Intravenous solutions in the care of patients with volume depletion and electrolyte abnormalities. Am J Kidney Dis. 2015; 66:147-53.
  11.  Chuang CL. Fluid management in acute kidney injury. Contrib Nephrol. 2016; 187:84-93.
  12. Warren J, Mehran R, Baber U, Xu K, Giacoppo D, Gersh BJ, et al. Incidence and impact of acute kidney injury in patients with acute coronary syndromes treated with coronary artery bypass grafting: Insights from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and Acute Cathete-rization and Urgent Intervention Triage Strategy (ACUITY) trials. Am Heart J. 2016; 171:40-7.
  13. Gallagher S, Jones DA, Lovell MJ, Hassan S, Wragg A, Kapur A, et al. The impact of acute kidney injury on midterm outcomes after coronary artery bypass graft surgery: a matched propensity score analysis. J Thorac Cardiovasc Surg 2014; 147:989-95.
  14. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005; 16:3365–70.
  15. Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, DrumlW, Bauer P, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004; 15:1597–605.
  16. Wróbel P, Wyrwicz-Zielińska G, Krzysztonek-Weber I, Sułowicz W. Clinical characteristic of patients with acute kidney injury complicated severe cardio-vascular diseases. Przegl Lek. 2015; 73(1):15-9.
  17. Lira A, Pinsky MR. Choices in fluid type and volume during resuscitation: impact on patient outcomes. Ann Intensive Care. 2014; 4:38.
  18.  Burdett E, Dushianthan A, Bennett-Guerrero E, Cro S, Gan TJ, Grocott MP, et al. Perioperative buffered versus non-buffered fluid administration for surgery in adults. Cochrane Database Syst Rev. 2012; 12:CD004089.