• Isabell A Just, Farnoush Alborzi, Maren Godde, Sascha Ott, Alexander Meyer, Julia Stein, Stefan Mazgareanu, Markus van der Giet, Kai M Schmidt-Ott, Volkmar Falk, and Felix Schoenrath.
• Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany. Electronic address: ijust@dhzb.de.
• J. Cardiothorac. Vasc. Anesth. 2022 Feb 1; 36 (2): 444-451.

ObjectiveAcute kidney injury (AKI) is a common complication after cardiac surgery (CS). Because a therapeutic regimen remains scarce, the early implementation of preventive strategies is crucial. The authors investigated risk factors and the typical clinical course of CS-associated AKI (CS-AKI) to derive strategies for perioperative clinical routines.DesignRetrospective data analysis.SettingThe data were collected from clinical routines in a maximum care university hospital.ParticipantsPatients.InterventionsThe authors retrospectively analyzed data from 538 patients who underwent CS.Measurements And Main ResultsThe median age of the 466 patients included was 66.6 years; 65.7% were men. AKI occurred in 131 (28.1%) patients, mainly (89.0%) starting postoperatively within 72 hours p. Thirty-one (6.7%) patients showed Kidney Disease Improving Global Outcome AKI stage 3. AKI was significantly more frequent in patients with chronic kidney disease (p < 0.001), emergency admission (p < 0.001), heart failure (p < 0.001), and postoperative complications (p < 0.001). In a multivariate analysis, postoperative CS-AKI risk significantly decreased with each 1 or 10 mL/min preoperative glomerular filtration rate (GFR) (odds ratio, 0.962 and 0.677; 95% confidence interval, 0.947-0.977 and 0.577-0.793; p < 0.001 and p < 0.0001). Only in patients who developed Kidney Disease Improving Global Outcome AKI stage 3, an early postoperative trend to decreased GFR and increased creatinine levels was observed.ConclusionsEspecially in patients with preexisting CKD and signs of CS-AKI occurring on the day of surgery, close monitoring of renal function should be performed for at least 72 hours after CS to detect an onset of AKI early and initiate renal protective strategies. Optimal preoperative fluid management might prevent postoperative AKI.Copyright © 2021 Elsevier Inc. All rights reserved.

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