1. Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury
- Author
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Carmelo A. Milano, Ian J. Welsby, Michael W. Manning, Dean Linder, John C. Haney, Yi-Hung Wu, Madhav Swaminathan, Mihai V. Podgoreanu, Kamrouz Ghadimi, Jacob N. Schroder, Mark Stafford-Smith, and Yi-Ju Li
- Subjects
Adult ,medicine.medical_specialty ,Ultrafiltration ,Blood volume ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Article ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,030202 anesthesiology ,law ,Cardiopulmonary bypass ,Humans ,Medicine ,Prospective Studies ,Cardiac Surgical Procedures ,Prospective cohort study ,Retrospective Studies ,Cardiopulmonary Bypass ,business.industry ,Acute kidney injury ,Retrospective cohort study ,Acute Kidney Injury ,medicine.disease ,female genital diseases and pregnancy complications ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Quartile ,Elective Surgical Procedures ,Anesthesia ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
OBJECTIVE: Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) serves to hemoconcentrate blood volume to avoid allogeneic blood transfusions. Previous studies have determined weight-indexed CUF volumes as a continuous variable are associated with postoperative AKI after cardiac surgery but optimal weight-indexed volumes that predict AKI have not been described. DESIGN: Retrospective cohort SETTING: Single-center university hospital PARTICIPANTS: 1,641 consecutive patients that underwent elective cardiac surgery between June 2013-December 2015. INTERVENTIONS: CUF volume was removed during CPB in all participants as part of our routine practice. We investigated the association of dichotomized weight indexed CUF volume removal with postoperative AKI development to provide pragmatic guidance for clinical practice at our institution. MEASUREMENTS AND MAIN RESULTS: Primary outcomes of postoperative AKI was defined by the KDIGO staging criteria and dichotomized, weight indexed CUF volumes (ml/kg) were defined by (i) extreme quartiles (Q3) and by (ii) Youden’s criterion that best predicted AKI development. Multivariable logistic regression models were developed to test the association of these dichotomized indices with AKI status. Postoperative AKI occurred in 827 patients (50.4%). Higher CUF volumes were associated with AKI development by quartiles (CUF >Q(3)=32.6 vs. CUF 32 mL/kg increased the risk for postoperative AKI development. Importantly, CUF volume removal of any amount did not mitigate allogeneic blood transfusion during elective cardiac surgery. Prospective studies are needed to validate these findings.
- Published
- 2021