Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.016
Brazilian Journal of Anesthesiology
Clinical Research

Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria

Incidência de lesão renal aguda pós-cirurgia cardíaca: uma comparação dos critérios AKIN e KDIGO

Tiago Furquim da Silva, Kelly Regina da Cruz Silva, Crissiane Melo Nepomuceno, Cora Salles Maruri Corrêa, João Pedro Mello Godoy, Ari Tadeu Lírio dos Santos, Alessandra Sarturi Gheller

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Abstract

Background and objectives
Data on urine output have not been routinely presented to define cardiac surgery-related acute kidney injury (AKI). We evaluated the incidence of AKI after cardiac surgery based on the AKIN and KDIGO criteria (considering serum creatinine concentration and urine output in the first 72 hours postoperatively) and compared the performance of the 2 criteria for AKI staging.

Methods
This was a prospective cohort study of adult patients undergoing coronary artery bypass grafting (CABG), valve replacement, or CABG + valve replacement between October 2017 and April 2018 at a single institution. Patients were excluded if baseline creatinine concentration (measured within 7 days before surgery) was ≥ 2.5 mg.dL-1. Patients were evaluated for the development of AKI based on changes in urine output and serum creatinine concentration, measured daily from postoperative day 1 to 7, according to the AKIN and KDIGO criteria, which were then compared.

Results
A total of 198 patients were included. AKI occurred in 83.8% by AKIN and in 82.8% by KDIGO, when using both urine output and serum creatinine concentration as defining criteria. Using serum creatinine concentration alone, the incidence of AKI fell to 27.3% by AKIN and to 24.7% by KDIGO. A kappa coefficient of 0.98 was obtained between the AKIN and KDIGO criteria.

Conclusions
Almost perfect agreement was found between AKIN and KDIGO. AKI may be underdiagnosed after cardiac surgery if serum creatinine concentration is used as the only defining criterion. Our findings underscore the fundamental importance of using the urine output criterion in the assessment of patients at risk for AKI.

Keywords

Acute kidney injury;  Cardiac surgery;  Serum creatinine;  Urine output;  Intensive care;  Postoperative care

Resumo

Justificativa e objetivos: Os dados sobre o débito urinário não foram apresentados rotineiramente para definir a lesão renal aguda (LRA) relacionada à cirurgia cardíaca. Avaliamos a incidência de IRA após cirurgia cardíaca com base nos critérios AKIN e KDIGO (considerando a concentração de creatinina sérica e débito urinário nas primeiras 72 horas de pós-operatório) e comparamos o desempenho dos 2 critérios para estadiamento da IRA. Métodos: Este foi um estudo de coorte prospectivo de pacientes adultos submetidos à cirurgia de revascularização do miocárdio (CRM), troca valvar ou CRM + troca valvar entre outubro de 2017 e abril de 2018 em uma única instituição. Os pacientes foram excluídos se a concentração basal de creatinina (medida dentro de 7 dias antes da cirurgia) fosse ≥ 2,5 mg.dL-1. Os pacientes foram avaliados quanto ao desenvolvimento de LRA com base nas alterações do débito urinário e da concentração de creatinina sérica, medidas diariamente do 1º ao 7º dia de pós-operatório, de acordo com os critérios AKIN e KDIGO, que foram então comparados. Resultados: Um total de 198 pacientes foram incluídos. A IRA ocorreu em 83,8% pelo AKIN e em 82,8% pelo KDIGO, utilizando tanto o débito urinário quanto a concentração de creatinina sérica como critérios definidores. Usando apenas a concentração de creatinina sérica, a incidência de IRA caiu para 27,3% pelo AKIN e para 24,7% pelo KDIGO. Um coeficiente kappa de 0,98 foi obtido entre os critérios AKIN e KDIGO. Conclusões: uma concordância quase perfeita foi encontrada entre AKIN e KDIGO. A LRA pode ser subdiagnosticada após cirurgia cardíaca se a concentração de creatinina sérica for usada como único critério de definição. Nossos achados reforçam a importância fundamental do uso do critério de débito urinário na avaliação de pacientes com risco para LRA.

Palavras-chave

Lesão renal aguda; Cirurgia cardíaca; Creatinina sérica; Saída de urina; Tratamento intensivo; Cuidados pós-operatórios

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