• Julie Ho, Martina Reslerova, Brent Gali, Peter W Nickerson, David N Rush, Manish M Sood, Joe Bueti, Paul Komenda, Edward Pascoe, Rakesh C Arora, and Claudio Rigatto.
• Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
• Am. J. Kidney Dis. 2012 Feb 1;59(2):196-201.

BackgroundAfter heart surgery, acute kidney injury (AKI) confers substantial long-term risk of death and chronic kidney disease. We hypothesized that small changes in serum creatinine (SCr) levels measured within a few hours of exit from the operating room could help discriminate those at low versus high risk of AKI.Study DesignProspective cohort of 350 elective cardiac surgery patients (valve or coronary artery bypass grafting) recruited in Winnipeg, Canada. Baseline SCr level was obtained at the preoperative visit 2 weeks before surgery. The postoperative SCr level was drawn within 6 hours of completion of surgery and then daily while the patient was in the hospital.PredictorImmediate (ie, <6 hours) postoperative SCr level change (ΔSCr), categorized as within 10% (reference), decrease >10%, or increase >10% relative to baseline.OutcomeAKI, defined according to the new KDIGO (Kidney Disease: Improving Global Outcomes) consensus definition as an increase in SCr level >0.3 mg/dL within 48 hours or >1.5 times baseline within 1 week.MeasurementsWe compared the C statistic of logistic models with and without inclusion of immediate postoperative ΔSCr.ResultsAfter surgery, 176 patients (52%) experienced a decrease >10% in SCr level, 26 (7.4%) experienced an increase >10%, and 143 had ΔSCr within ±10% of baseline. During hospitalization, 53 (14%) developed AKI. Bypass pump time, baseline estimated glomerular filtration rate, and European System for Cardiac Operative Risk Evaluation (euroSCORE) were associated with AKI in a parsimonious base logistic model. Added to the base model, immediate postoperative ΔSCr was associated strongly with subsequent AKI and significantly improved model discrimination over the base model (C statistic, 0.78 [95% CI, 0.71-0.85] vs 0.69 [95% CI, 0.62-0.77]; P < 0.001). A ≥10% SCr level decrease predicted significantly lower AKI risk (OR, 0.37; 95% CI, 0.18-0.76), whereas a ≥10% SCr level increase predicted significantly higher (OR, 6.38; 95% CI, 2.37-17.2) AKI risk compared with the reference category.LimitationsWe used a surrogate marker of AKI. External validation of our results is warranted.ConclusionIn elective cardiac surgery patients, measurement of immediate postoperative ΔSCr improves prediction of AKI.Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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