Risk factors affecting prognosis in patients undergoing continuous renal replacement therapy for acute kidney injury after extracorporeal circulation surgery_West China Medical Journal

Authors：

YANG Enhao , WEN Yang ,  DU Xiaogang

Nephrology Department, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, P. R. China;

Corresponding author：

DU Xiaogang, Email: cqmudxg@163.com

Keywords：

Extracorporeal circulation; acute kidney injury; continuous renal replacement therapy; prognosis

DOI：

10.7507/1002-0179.202406094

Video：

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Objective To explore the risk factors affecting the prognosis of patients with acute kidney injury (AKI) after extracorporeal circulation surgery who receive continuous renal replacement therapy (CRRT). Methods Patients who developed AKI and underwent CRRT treatment after extracorporeal circulation surgery at the First Affiliated Hospital of Chongqing Medical University between May 2019 and May 2024 were retrospectively selected. According to the prognosis, patients were divided into the good prognosis group and the poor prognosis group. Basic information, duration of extracorporeal circulation during surgery, aortic occlusion time, timing and duration of CRRT initiation therapy, relevant laboratory indicators before surgery, during CRRT intervention, and upon discharge or death were collected. The risk factors affecting the prognosis of such patients were analyzed. Results A total of 45 patients were included. Among them, there were 20 cases in the good prognosis group and 25 cases in the poor prognosis group. There was no statistically significant difference in the basic information between the two groups (P>0.05). Compared with the poor prognosis group, the good prognosis group had decreased preoperative urea nitrogen and increased hemoglobin levels, reduced levels of alanine aminotransferase and aspartate aminotransferase during the initiation of CRRT treatment, and reduced levels of white blood cell count, neutrophil percentage, alanine aminotransferase and aspartate aminotransferase and elevated platelet count before discharge or death (P<0.05). The results of multivariate logistic regression analysis showed that the total duration of CRRT treatment [odds ratio (OR)=1.007, 95% confidence interval (CI) (1.000, 1.015), P=0.046], white blood cell count before discharge or death [OR=1.541, 95%CI (1.011, 2.349), P=0.044], and platelet count before discharge or death [OR=0.964, 95%CI (0.937, 0.991), P=0.010] could affect patient prognosis. Conclusions In patients with AKI after extracorporeal circulation surgery, if combined with renal dysfuction and anemia before surgery, liver function damage and secondary infection during CRRT initiation therapy may be related to poor patient prognosis. The longer the duration of CRRT treatment, the higher the white blood cells before discharge or death, and the lower the platelet count are independent risk factors for poor prognosis in patients.

1.	Jayaraman R, Sunder S, Sathi S, et al. Post cardiac surgery acute kidney injury: a woebegone status rejuvenated by the novel biomarkers. Nephrourol Mon, 2014, 6(4): e19598.
2.	Leballo G, Moutlana HJ, Muteba MK, et al. Factors associated with acute kidney injury and mortality during cardiac surgery. Cardiovasc J Afr, 2021, 32(6): 308-313.
3.	Rafiq Abbasi MS, Sultan K, Manzoor R, et al. Assessment of renal function and prevalence of acute kidney injury following coronary artery bypass graft surgery and associated risk factors: a retrospective cohort study at a tertiary care hospital in Islamabad, Pakistan. Medicine (Baltimore), 2023, 102(42): e35482.
4.	Luckraz H, Gravenor MB, George R, et al. Long and short-term outcomes in patients requiring continuous renal replacement therapy post cardiopulmonary bypass. Eur J Cardiothorac Surg, 2005, 27(5): 906-909.
5.	Gao S, Liu G, Yan S, et al. Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019. Perfusion, 2022, 37(3): 235-241.
6.	Soh S, Shim JK, Song JW, et al. Perioperative nadir hemoglobin concentration and outcome in off-pump coronary artery bypass surgery-a retrospective review. Circ J, 2020, 85(1): 37-43.
7.	Fleming F, Bohn D, Edwards H, et al. Renal replacement therapy after repair of congenital heart disease in children. A comparison of hemofiltration and peritoneal dialysis. J Thorac Cardiovasc Surg, 1995, 109(2): 322-331.
8.	周立新, 谭家驹, 李铁男, 等. 严重脓毒症免疫炎症反应紊乱及双向免疫调节的前瞻性随机对照研究. 中华医学杂志, 20029, 89(15): 1028-1033.
9.	Besen BAMP, Romano TG, Mendes PV, et al. Early versus late initiation of renal replacement therapy in critically ill patients: systematic review and Meta-analysis. J Intensive Care Med, 2019, 34(9): 714-722.
10.	Karkar A, Ronco C. Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care, 2020, 10(1): 32.
11.	Ricci Z, Romagnoli S, Reis T, et al. Hemoperfusion in the intensive care unit. Intensive Care Med, 2022, 48(10): 1397-1408.
12.	Träger K, Fritzler D, Fischer G, et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs, 2016, 39(3): 141-146.
13.	Bottari G, Lorenzetti G, Severini F, et al. Role of hemoperfusion with cytosorb associated with continuous kidney replacement therapy on renal outcome in critically Ⅲ children with septic shock. Front Pediatr, 2021, 9: 718049.
14.	Mehta Y, Paul R, Ansari AS, et al. Extracorporeal blood purification strategies in sepsis and septic shock: an insight into recent advancements. World J Crit Care Med, 2023, 12(2): 71-88.
15.	朱铭力, 倪兆慧, 严玉澄, 等. 肾脏替代治疗时间对重症急性肾衰竭患者后的影响. 中华危重病急救医学, 2011, 23(7): 421-425.
16.	Pluta MP, Dziech M, Klocek T, et al. Diagnostic accuracy of platelet-derived parameters in prognostication in neurosurgery. Int J Environ Res Public Health, 2022, 19(12): 7115.
17.	Van Eldere A, Pirani T. Liver intensive care for the general intensivist. Anaesthesia, 2023, 78(7): 884-901.
18.	Acar U, Gökkaya Z, Akbulut A, et al. Impact of cytokine adsorption treatment in liver Failure. Transplant Proc, 2019, 51(7): 2420-2424.

1. Jayaraman R, Sunder S, Sathi S, et al. Post cardiac surgery acute kidney injury: a woebegone status rejuvenated by the novel biomarkers. Nephrourol Mon, 2014, 6(4): e19598.
2. Leballo G, Moutlana HJ, Muteba MK, et al. Factors associated with acute kidney injury and mortality during cardiac surgery. Cardiovasc J Afr, 2021, 32(6): 308-313.
3. Rafiq Abbasi MS, Sultan K, Manzoor R, et al. Assessment of renal function and prevalence of acute kidney injury following coronary artery bypass graft surgery and associated risk factors: a retrospective cohort study at a tertiary care hospital in Islamabad, Pakistan. Medicine (Baltimore), 2023, 102(42): e35482.
4. Luckraz H, Gravenor MB, George R, et al. Long and short-term outcomes in patients requiring continuous renal replacement therapy post cardiopulmonary bypass. Eur J Cardiothorac Surg, 2005, 27(5): 906-909.
5. Gao S, Liu G, Yan S, et al. Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019. Perfusion, 2022, 37(3): 235-241.
6. Soh S, Shim JK, Song JW, et al. Perioperative nadir hemoglobin concentration and outcome in off-pump coronary artery bypass surgery-a retrospective review. Circ J, 2020, 85(1): 37-43.
7. Fleming F, Bohn D, Edwards H, et al. Renal replacement therapy after repair of congenital heart disease in children. A comparison of hemofiltration and peritoneal dialysis. J Thorac Cardiovasc Surg, 1995, 109(2): 322-331.
8. 周立新, 谭家驹, 李铁男, 等. 严重脓毒症免疫炎症反应紊乱及双向免疫调节的前瞻性随机对照研究. 中华医学杂志, 20029, 89(15): 1028-1033.
9. Besen BAMP, Romano TG, Mendes PV, et al. Early versus late initiation of renal replacement therapy in critically ill patients: systematic review and Meta-analysis. J Intensive Care Med, 2019, 34(9): 714-722.
10. Karkar A, Ronco C. Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care, 2020, 10(1): 32.
11. Ricci Z, Romagnoli S, Reis T, et al. Hemoperfusion in the intensive care unit. Intensive Care Med, 2022, 48(10): 1397-1408.
12. Träger K, Fritzler D, Fischer G, et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs, 2016, 39(3): 141-146.
13. Bottari G, Lorenzetti G, Severini F, et al. Role of hemoperfusion with cytosorb associated with continuous kidney replacement therapy on renal outcome in critically Ⅲ children with septic shock. Front Pediatr, 2021, 9: 718049.
14. Mehta Y, Paul R, Ansari AS, et al. Extracorporeal blood purification strategies in sepsis and septic shock: an insight into recent advancements. World J Crit Care Med, 2023, 12(2): 71-88.
15. 朱铭力, 倪兆慧, 严玉澄, 等. 肾脏替代治疗时间对重症急性肾衰竭患者后的影响. 中华危重病急救医学, 2011, 23(7): 421-425.
16. Pluta MP, Dziech M, Klocek T, et al. Diagnostic accuracy of platelet-derived parameters in prognostication in neurosurgery. Int J Environ Res Public Health, 2022, 19(12): 7115.
17. Van Eldere A, Pirani T. Liver intensive care for the general intensivist. Anaesthesia, 2023, 78(7): 884-901.
18. Acar U, Gökkaya Z, Akbulut A, et al. Impact of cytokine adsorption treatment in liver Failure. Transplant Proc, 2019, 51(7): 2420-2424.

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