The effect of timing of cardiac catheterization on acute kidney injury after cardiac surgery is influenced by the type of operation

• Published in: International journal of cardiology 2014-04, Vol.173 (1), p.46-54
• Main Authors: Mariscalco, Giovanni, Cottini, Marzia, Dominici, Carmelo, Banach, Maciej, Piffaretti, Gabriele, Borsani, Paolo, Bruno, Vito Domenico, Corazzari, Claudio, Gherli, Riccardo, Beghi, Cesare
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac catheterization; Cardiac Catheterization - methods; Cardiac surgery; Cardiac Surgical Procedures - adverse effects; Cardiology. Vascular system; Cardiopulmonary bypass; Cardiovascular; Coronary Artery Bypass - adverse effects; CPB; Female; Heart; Heart Valve Prosthesis Implantation - adverse effects; Humans; Kidneys; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Prospective Studies; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Treatment Outcome; Urinary system involvement in other diseases. Miscellaneous; Young Adult
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.02.010

Abstract Background Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive. Methods A total of 2504 consecutive nonemergent patients undergoing isolated coronary artery bypass grafting (CABG), valve surgery (with or without concomitant CABG), and proximal aortic procedures were enrolled. AKI was defined by consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The association of postoperative AKI and time between cardiac catheterization and operation was evaluated using multivariable logistic regression modeling and propensity-matched analysis. Results Postoperative AKI occurred in 230 (9%) patients. The median number of days from cardiac catheterization to operation was 5 (25th to 75th percentile: 2 to 10). The incidence of AKI was significantly higher in patients operated on ≤ 1 day after cardiac catheterization compared to those operated on > 1 day after (13% vs. 8%, p = 0.004). The time interval between cardiac catheterization and surgery (tested both as a continuous and a categorical variable) was not an independent AKI predictor in the propensity-matched population or the pre-matched one. Contrast exposure ≤ 1 day before surgery was independently associated with postoperative AKI in patients undergoing valve surgery with concomitant CABG only (post-matched: OR 3.68, 95%CI 1.30 to 10.39, p = 0.014). Conclusions Delaying cardiac surgery beyond 24 h of exposure to contrast agents seems to be justified only in patients undergoing valve surgery with concomitant CABG.