Retrospective analysis of postoperative acute kidney injury in patients underwent open chest multivalvular replacement surgery

Zhang Hui; Zhang Tao-yuan; Wang Miao; Zhi Wei-wei; Chen Wei

doi:10.13498/j.cnki.chin.j.ecc.2017.03.06

Abstract：Objective To investigate the incidence and risk factors of acute kidney injury (AKI) after open chest multivalvular replacement surgery.Methods 400 patients who received multivalvular (mitral valve plus aortic valve) replacement surgery from May 1st,2011 to June 30th,2013 in the First Affiliated Hospital of the Fourth Military Medical University were retrospectively analyzed.Multivariate logistic regression analysis was used to determine the risk factors associated with postoperative AKI.AKI was defined according to AKIN as an absolute increment of 26.4 μmol/L in Scr or a relative 50％ increment of Scr within 48 hours and/or urine volume < 0.5 ml /(kg·h) up to 6 hours.Results Of all the 400 patients underwent multivalvular (mitral valve plus aortic valve) replacement surgery,the incidence of AKI was 76％,whereas 11 patients (2.75％) needed renal replacement therapy.Univariate analysis of risk factors for the development of AKI in multivalvular replacement surgery demonstrated significant differences in age,gender,body mass index,end-diastolic volume,eGFR,preoperative hypertension,time of surgery and time of cardiopulmonary bypass between AKI group and non-AKI group.In multivariate logistic regression analysis,advanced age,male gender,increased body mass index,preoperative eGFR<60 ml/(min·1.73 m2) were all identified to be associated with development of AKI independently,and the corresponding OR values were 1.66,2.38,1.15,2.12 and 2.65 respectively.Conclusion AKI is the most common adverse event after multivalvular replacement surgery.Advanced age,male gender,increased body mass index,preoperative eGFR<60 ml/(min·1.73m2) are independent risk factors of postoperative AKI for patients underwent this procedure.The value of preventative and therapeutic strategies to reduce AKI and theirs effects should be investigated further.