Nadir oxygen delivery on bypass and hypotension increase acute kidney injury risk after cardiac operations

J. Trent Magruder, Samuel P. Dungan, Joshua C. Grimm, H. Lynn Harness, Chad Wierschke, Stephen Castillejo, Viachaslau Barodka, Nevin Katz, Ashish S. Shah, Glenn J. Whitman

Research output: Contribution to journalArticle

Abstract

Background Acute kidney injury (AKI) continues to complicate cardiac operations. We sought to determine whether nadir oxygen delivery (DO2) on cardiopulmonary bypass (CPB) was a risk factor for AKI while also accounting for other postoperative factors. Methods Using propensity scoring, we matched 85 patients who developed AKI after cardiac operations on CPB with 85 control patients who did not. We analyzed the following variables through midnight on postoperative day 1 (POD1): DO2, antibiotics, blood products and vasopressors (intraoperatively and postoperatively), and hemodynamic variables. Results Univariable analysis revealed AKI patients had lower nadir DO2 on CPB (208 vs 230 mL O2/min/m2 body surface area, p = 0.03), lower intensive care unit admission blood pressure gradient across the kidney (mean arterial pressure minus central venous pressure; 60 vs 68 mm Hg; p < 0.001), a greater proportion of patients with mean arterial pressure of less than 60 mm Hg for more than 15 minutes in the postoperative period (70% vs 42%, p < 0.001), a greater chance of having a cardiac index of less than 2.2 (74% vs 49%, p = 0.02), and greater total vasopressor use through the end of POD1 (5.2 vs 2.3 mg, p = 0.002). On multivariable analysis, predictors of AKI were a DO2 on CPB of less than 225 mL O2/min/m2 (odds ratio, 2.46; 95% confidence interval, 1.21 to 5.03; p = 0.01) and postoperative mean arterial pressure of less than 60 mm Hg for more than 15 minutes (odds ratio, 3.96; 95% confidence interval, 1.92 to 8.20; p < 0.001). An average postoperative pressor dose greater than 0.03 μg/kg/min did not reach significance (odds ratio, 1.98; 95% confidence interval, 0.95 to 4.11; p = 0.07). Conclusions Postoperative hypotension on POD0 or POD1 and low DO2 on CPB both independently increase the AKI risk in cardiac surgical patients.

Original languageEnglish (US)
Pages (from-to)1697-1703
Number of pages7
JournalAnnals of Thoracic Surgery
Volume100
Issue number5
DOIs
StatePublished - Nov 2015

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ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Magruder, J. T., Dungan, S. P., Grimm, J. C., Harness, H. L., Wierschke, C., Castillejo, S., Barodka, V., Katz, N., Shah, A. S., & Whitman, G. J. (2015). Nadir oxygen delivery on bypass and hypotension increase acute kidney injury risk after cardiac operations. Annals of Thoracic Surgery, 100(5), 1697-1703. https://doi.org/10.1016/j.athoracsur.2015.05.059