• Roderica Rui Ge Ng, Sophia Tsong Huey Chew, Weiling Liu, and Lian Kah Ti.
• Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
• J. Cardiothorac. Vasc. Anesth. 2014 Dec 1; 28 (6): 1453-8.

ObjectiveAcute kidney injury is a serious complication after cardiac surgery. Although it resolves in most cases, a significant portion of patients persistently have raised creatinine values at hospital discharge. These patients are at greater risk for developing chronic kidney disease and mortality. Therefore, the present study aimed to ascertain risk factors of persistent acute kidney injury after cardiac surgery in patients with normal preoperative renal function.DesignProspective cohort study.SettingTertiary heart centers.Participants2,181 adult cardiac surgical patients, predominantly Asian.InterventionsCardiac surgery between August 2008 and July 2012.Measurements And Main ResultsThe incidence of acute kidney injury, as defined by the Acute Kidney Injury Network stage 1 criteria, was 21.7%. At discharge, 10.5% of these patients had persistent kidney injury, which was defined as a ≥ 26.4 μmol/L (≥ 0.3 mg/dL) difference between preoperative and discharge creatinine levels and/or a 50% rise in serum creatinine. These patients were more likely to be aged ≥ 70 years (relative risk = 2.232, 95% confidence interval = 1.326-3.757, p = 0.003), have a higher peak postoperative creatinine value within 48 hours (relative risk = 1.007, 95% confidence interval = 1.004-1.010, p<0.001), and have lower hemoglobin on intensive care unit arrival (relative risk = 0.759, 95% confidence interval = 0.577-0.998, p = 0.048).ConclusionsAge ≥ 70 years, higher peak postoperative creatinine within 48 hours, and lower hemoglobin on intensive care unit arrival are associated with persistent acute kidney injury. Strategies to improve hemoglobin on intensive care unit arrival potentially can reduce persistent acute kidney injury. The authors recommend that patients aged ≥ 70 years undergo further renal evaluation for better risk stratification.Copyright © 2014 Elsevier Inc. All rights reserved.

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