Acta Medica Okayama volume75 issue5
2021-10 発行

Factors for Acute Kidney Injury Following Total Arch Replacement and Association with Temperature Management During Cardiopulmonary Bypass: A Single-center Retrospective Observational Study

Omiya, Hiroki Department of Anesthesiology and Critical Care Medicine, Hiroshima Citizens Hospital
Takatori, Makoto Department of Anesthesiology and Critical Care Medicine, Hiroshima Citizens Hospital
Yunoki, Keiji Department of Cardiovascular Surgery, Hiroshima Citizens Hospital
Morimatsu, Hiroshi Department of Anesthesiology and Resuscitation, Okayama University Hospital
Publication Date
2021-10
Abstract
Many patients develop acute kidney injury (AKI) after vascular surgery. In this retrospective observational study, we investigated the risk factors for AKI defined using the Kidney Disease Improving Global Outcomes criteria after total arch replacement (TAR). Additionally, we investigated the influence of temperature manage-ment during cardiopulmonary bypass (CPB) on postoperative renal function by propensity score-matched anal-ysis. We retrospectively analyzed 161 consecutive patients who underwent TAR between 2016 and 2019. Postoperative AKI occurred in 48.7% of the patients. In the multivariate analysis, male sex (odds ratio [OR] 3.95, 95% confidence interval [95%CI] 1.56-8.27, p = 0.002), ACE inhibitors/ARB medication (OR 3.19, 95%CI 1.49-6.82, p = 0.003), preoperative chronic kidney disease (OR 2.47, 95%CI 1.17-5.23, p = 0.02), pro-longed CPB time (OR 2.36, 95%CI 1.05-5.34, p = 0.04), and lower body ischemic time during CPB (OR 2.20, 95%CI 1.05-4.46, p = 0.04) were identified as independent risk factors for AKI. Propensity score-matched anal-ysis showed no significant difference in the risk of AKI following TAR between mild hypothermia or normo-thermia and moderate hypothermia (37.2% vs. 41.9%, p = 0.83). In conclusion, modifiable risk factors for AKI included prolonged CPB time and lower body ischemic time. Temperature management during CPB had no clear effect on outcomes.
Document Type
Original Article
Keywords
acute kidney injury
total arch replacement
cardiopulmonary bypass
lower body ischemic time
Link to PubMed
75_5_585.pdf 2.03 MB