Renal Angina Is a Sensitive, but Nonspecific Identifier of Postcardiac Surgery Acute Kidney Injury

• Published in: Journal of cardiothoracic and vascular anesthesia 2019-02, Vol.33 (2), p.357-364
• Main Authors: Fierro, Michael A., Ehieli, Eric I., Cooter, Mary, Traylor, Austin, Stafford-Smith, Mark, Swaminathan, Madhav
• Format: Article
• Language: English
• Subjects: acute kidney injury; Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Aged; Biomarkers - blood; cardiac surgery; Cardiac Surgical Procedures - adverse effects; Creatinine - blood; critical care; Early Diagnosis; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Incidence; Male; Middle Aged; North Carolina - epidemiology; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Predictive Value of Tests; renal angina; Retrospective Studies; ROC Curve; sensitivity and specificity
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2018.07.017

Acute kidney injury (AKI) is a common complication of cardiac surgery, and early detection is difficult. This study was performed to determine the sensitivity, specificity, positive predictive value, negative predictive value, and statistical performance of renal angina (RA) as an early predictor of AKI in an adult cardiac surgical patient population. Retrospective, nonrandomized, observational study. A single, university-affiliated, quaternary medical center. The study comprised 324 consecutive patients undergoing coronary artery bypass grafting or cardiac valvular surgery from February 1 through July 30, 2014. None. One hundred-seven patients at moderate or high risk of developing postoperative renal injury were identified, 82 of whom met criteria for RA. The occurrence of RA was found to have an 80.9% sensitivity and 30.8% specificity for the prediction of AKI using Acute Kidney Injury Network criteria and 89.3% sensitivity and 27.8% specificity when paired with the Risk, Injury, Failure, Loss, End Stage Renal Disease criteria. A receiver operating characteristic area under the curve analysis revealed a nonsignificant predictive ability of 55.8% (95% confidence interval 0.47-0.65) when RA was paired with Acute Kidney Injury Network criteria; however, the receiver operating characteristic area under the curve was significant when paired with Risk, Injury, Failure, Loss, End Stage Renal Disease criteria, with a predictive ability of 0.586 (0.509-0.662). RA is a sensitive, but nonspecific, predictor of postcardiac surgery AKI, with clinical utility most suited as a screening tool.