Kidney Injury in Those Having Angiography and Heart Surgery
Kidney Injury in Those Having Angiography and Heart Surgery
Aims Cardiac surgery and coronary angiography are both associated with risk of acute kidney injury (AKI). We hypothesized that the risk of post-operative AKI increases when coronary angiogram and cardiac surgery are performed in close succession, without sufficient time for recovery from the adverse effects of intravenous contrast.
Methods and results We included 2133 consecutive patients who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center from 2004 to 2010. Acute kidney injury was defined by the AKI network and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Patients were 66 ± 10 years old. Mean pre-operative creatinine and estimated glomerular filtration rate were 1.1 ± 0.4 mg/dL and 75 ± 22 mL/min/1.73 m, respectively. Cardiac surgery was performed 14 days (range 0–235) after coronary angiography. Acute kidney injury occurred in 680 (32%) patients per AKI network, 390 (18%) patients per RIFLE risk, and 111 (5%) patients per RIFLE injury criteria. Age, body mass index, diabetes mellitus, New York Heart Association class III/IV, cardiopulmonary bypass time, and impaired pre-operative renal function were independent predictors of AKI. However, time between coronary angiogram and cardiac surgery was not a predictor (P = 0.41). AKI occurred in 35% of 433 patients operated within 3 days of coronary angiogram vs. 31% of 1700 patients operated after 3 days (P = 0.17). Results were the same in patients with impaired pre-operative renal function and those with contrast-induced nephropathy.
Conclusion Risk of AKI after cardiac surgery is not influenced by the time between coronary angiogram and cardiac surgery. These results do not support the notion of delaying cardiac surgery for the sole purpose of renal recovery after coronary angiogram.
Acute kidney injury (AKI) occurs in up to 30% of patients after cardiac surgery and has been associated with morbidity, mortality, and longer hospitalization. Age, pre-existing kidney disease, cardiopulmonary bypass time, intra-aortic balloon pump use, and valve surgery increase the risk of AKI after cardiac surgery. On the other hand, contrast-induced nephropathy after coronary angiography occurs in up to 10% of patients with normal renal function and up to 25% of patients with pre-existing renal impairment. Recently, there has been an interest in the temporal relationship between coronary angiography and cardiac surgery suggesting that a 'double hit' on the renal function in close succession increases the risk of AKI after cardiac surgery. However, these reports were limited by utilization of non-conventional definitions of post-operative AKI and relatively small sample size. The purpose of the present investigation was to assess the influence of the time between coronary angiography and cardiac surgery on the incidence of post-operative AKI in a large cohort of patients using the AKI network and Risk, Injury, Failure, Loss, End-stage (RIFLE) definitions of AKI. We hypothesized that the risk of AKI increases when coronary angiogram and cardiac surgery are performed in close succession, without sufficient time to allow kidney function to recover from the adverse effects of intravenous contrast.
Abstract and Introduction
Abstract
Aims Cardiac surgery and coronary angiography are both associated with risk of acute kidney injury (AKI). We hypothesized that the risk of post-operative AKI increases when coronary angiogram and cardiac surgery are performed in close succession, without sufficient time for recovery from the adverse effects of intravenous contrast.
Methods and results We included 2133 consecutive patients who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center from 2004 to 2010. Acute kidney injury was defined by the AKI network and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Patients were 66 ± 10 years old. Mean pre-operative creatinine and estimated glomerular filtration rate were 1.1 ± 0.4 mg/dL and 75 ± 22 mL/min/1.73 m, respectively. Cardiac surgery was performed 14 days (range 0–235) after coronary angiography. Acute kidney injury occurred in 680 (32%) patients per AKI network, 390 (18%) patients per RIFLE risk, and 111 (5%) patients per RIFLE injury criteria. Age, body mass index, diabetes mellitus, New York Heart Association class III/IV, cardiopulmonary bypass time, and impaired pre-operative renal function were independent predictors of AKI. However, time between coronary angiogram and cardiac surgery was not a predictor (P = 0.41). AKI occurred in 35% of 433 patients operated within 3 days of coronary angiogram vs. 31% of 1700 patients operated after 3 days (P = 0.17). Results were the same in patients with impaired pre-operative renal function and those with contrast-induced nephropathy.
Conclusion Risk of AKI after cardiac surgery is not influenced by the time between coronary angiogram and cardiac surgery. These results do not support the notion of delaying cardiac surgery for the sole purpose of renal recovery after coronary angiogram.
Introduction
Acute kidney injury (AKI) occurs in up to 30% of patients after cardiac surgery and has been associated with morbidity, mortality, and longer hospitalization. Age, pre-existing kidney disease, cardiopulmonary bypass time, intra-aortic balloon pump use, and valve surgery increase the risk of AKI after cardiac surgery. On the other hand, contrast-induced nephropathy after coronary angiography occurs in up to 10% of patients with normal renal function and up to 25% of patients with pre-existing renal impairment. Recently, there has been an interest in the temporal relationship between coronary angiography and cardiac surgery suggesting that a 'double hit' on the renal function in close succession increases the risk of AKI after cardiac surgery. However, these reports were limited by utilization of non-conventional definitions of post-operative AKI and relatively small sample size. The purpose of the present investigation was to assess the influence of the time between coronary angiography and cardiac surgery on the incidence of post-operative AKI in a large cohort of patients using the AKI network and Risk, Injury, Failure, Loss, End-stage (RIFLE) definitions of AKI. We hypothesized that the risk of AKI increases when coronary angiogram and cardiac surgery are performed in close succession, without sufficient time to allow kidney function to recover from the adverse effects of intravenous contrast.
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