• Calvin J de Wijs, Lucia W J M Streng, Robert Jan Stolker, Maarten Ter Horst, Ewout J Hoorn, MahtabEdris A FEAFDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, the Netherlands., Egbert G Mik, and Floor A Harms.
• Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands. Electronic address: c.dewijs@erasmusmc.nl.
• J Clin Anesth. 2024 Dec 9; 101: 111715111715.

BackgroundCardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication of cardiac surgery and is associated with increased morbidity and mortality. Recent guidelines emphasize the need for new monitoring methods to facilitate targeted CSA-AKI prevention and treatment strategies. In vivo real-time measurement of mitochondrial oxygen tension (mitoPO2), could potentially fulfil this role during cardiac surgery, as suggested in our previous pilot study.MethodsIn this prospective observational study, we investigated 75 cardiac surgery patients with an increased preoperative CSA-AKI risk. The primary aim of this study was to assess whether patients who developed CSA-AKI experienced prolonged periods of mitoPO2 < 20 mmHg during surgery. mitoPO2 was measured intraoperatively, and CSA-AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Four additional mitoPO2 thresholds (<25, <30, <35, and < 40 mmHg) were analyzed, including the predictive capacity of all thresholds for CSA-AKI.ResultsThis study found that patients who developed CSA-AKI had a significantly longer intraoperative time with mitoPO2 <20 mmHg and <25, <30, <35, and <40 mmHg. Subsequently, we tested all thresholds for their association with the risk of CSA-AKI, with the <25 mmHg threshold demonstrating the highest significant odds ratio. Every minute spent below <25 mmHg increased the risk of CSA-AKI by 0.7 % (P = 0.021).ConclusionsThis study highlighted the association between mitoPO2 and the onset of CSA-AKI. Extended durations below the mitoPO2 threshold of 25 mmHg significantly correlate with an elevated CSA-AKI risk. Using mitoPO2 as a monitoring tool shows promise in potentially predicting and possibly preventing CSA-AKI when used as a treatment trigger in cardiac surgery patients.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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