The prognostic value of using the duration of acute kidney injury in cardiac surgery: An example using two antifibrinolytics

Jeremiah R. Brown, Robert S. Kramer, Steven G. Coca, Chirag R. Parikh

Research output: Contribution to journalArticlepeer-review

Abstract

Previously, we reported that the addition of duration to the Acute Kidney Injury Network (AKIN) definition of acute kidney injury (AKI) is a marker for more severe kidney injury and predicts long-term mortality. We aimed to evaluate an example of the utility of adding AKI duration to the AKIN definition by comparing the historical use of aprotinin with Amicar. In a singlecenter observational study, we followed 4987 consecutive patients undergoing cardiac surgery between 2002 and 2007 for postsurgery AKI. Patients with a history of hemodialysis were excluded. Duration of AKI was calculated by the number of days AKI was present as defined by a 30.3 (mg/dL) or a 350% increase in serum creatinine from baseline or new onset of acute dialysis. Kaplan-Meier and Cox's proportional hazard modeling was conducted to evaluate 5-year mortality. Fifty-three percent of patients received Amicar (n = 2333) and 47% received high-dose aprotinin (n = 2093). Patients receiving aprotinin had evidence of more advanced disease and comorbidity and were more likely to develop AKI and have longer durations of AKI than Amicar (p < .001): 7.0 ± 11.5 vs. 3.8 ± 6.0 days (p < .001). Nearest-neighbor propensity matching demonstrated aprotinin had significantly worse 5-year mortality compared with Amicar (relative risk [RR] = 2.09, 95% confidence interval [CI] = 1.65-2.65). AKI duration added to the AKIN definition of AKI may provide the necessary sensitivity and specificity for evaluating renal outcomes in clinical trials.

Original languageEnglish (US)
Pages (from-to)227-231
Number of pages5
JournalJournal of Extra-Corporeal Technology
Volume43
Issue number4
StatePublished - 2011
Externally publishedYes

Keywords

  • Acute kidney injury
  • Amicar
  • Aprotinin
  • Cardiac outcomes
  • Cardiopulmonary bypass

ASJC Scopus subject areas

  • Medicine(all)

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