Perioperative Predictors of Acute Kidney Injury in Off-pump Coronary Artery Bypass Grafting Surgery

Introduction: Acute kidney injury (AKI) after cardiac surgery is associated with increased morbidity and mortality. Risk factors for AKI during off-pump coronary artery bypass grafting (OPCAB) are poorly understood. Our aim in this study is to identify the relationship between perioperative parameters and AKI following OPCAB.Method: This prospective observational study was conducted in a single tertiary cardiac center. A total of ۱۷۵ patients undergoing elective isolated CABG were included in this study over a ۲-year period (March ۲۰۲۱ – February ۲۰۲۳). Out of ۱۷۵ patients, ۳۴ developed acute kidney injury after off-pump coronary artery bypass grafting surgery. Their preoperative, intraoperative, and postoperative findings were compared to identify the independent risk factors for developing postoperative acute kidney injury.Result: The study was conducted on ۱۷۵ patients: ۱۱۳ males (۶۴.۵%) and ۶۲ females (۳۵.۵%). Their age ranged from ۶۱.۸۱±۸.۳۰ years. In the AKI group patients, independent risk factors for developing postoperative AKI consisted of age>۷۰ years (P<۰.۰۰۰۱), BMI>۳۰kg/m۲ (P=۰.۰۱۵), diabetes, high HbA۱c level (>۶.۵%) (P=<۰.۰۰۱), hypertension (P<۰.۰۰۱), no intake of calcium channel blockers for hypertension (P=<۰.۰۰۱), EF<۳۰%, and timing of angiography before surgery (< ۱۴days) (P=۰.۰۰۵).Conclusion: Independent risk factors for developing postoperative AKI consist of age>۷۰ years, BMI>۳۰kg/m۲, diabetes, high HbA۱c level (>۶.۵%), hypertension, no intake of calcium channel blockers for hypertension, EF<۳۰%, timing of angiography before surgery (<۱۴ days), Acute MI (<۳۰ days), High serum lactate level at ۱۲ hours post-ICU admission, high vasoactive inotropic score, and requirement of blood transfusion due to various reasons. Among all these variables, mortality was found as a strong predictor in AKI group patients (p=۰.۰۱۶, OR=۱۴.۹۵, ۹۵%CI ۱.۶۴-۱۳۶.۰۸).

کلیدواژه ها:

Acute kidney injury ، chronic kidney disease ، Off-pump coronary artery bypass grafting