Acute kidney injury after coronary artery bypass grafting and outcomes
Author: Rydén, Linda
Date: 2015-03-06
Location: Nanna Svartz Auditorium, Karolinska Universitetssjukhuset, Solna.
Time: 09.00
Department: Inst för medicin, Solna / Dept of Medicine, Solna
View/ Open:
Thesis (4.966Mb)
Abstract
Acute kidney injury (AKI) is a rapid reduction in glomerular filtration rate (GFR) that leads to a rise in serum creatinine (SCr). Acute kidney injury is common and patients with sepsis and patients who undergo cardiac surgery are at highest risk. Acute kidney injury is a potentially life-threatening complication that affects 9–40% of patients who undergo coronary artery bypass grafting (CABG). The associations between AKI and postoperative complications, long-term myocardial infarction (MI) risk, stroke and end-stage renal disease (ESRD) are not well described. The overall aims of this thesis are to study the associations between AKI after CABG and postoperative complications, short- and long-term mortality, long-term MI risk, stroke and ESRD.
Study I investigated the association between AKI after an initial isolated CABG and postoperative complications and death within 60 days of surgery. Of 7594 patients, 1047 (14%) patients developed AKI as defined by the Acute Kidney Injury Network (AKIN) classification. Patients with AKI had increased risk for death and postoperative complications. Multivariable adjusted odds ratios (OR) with 95% confidence intervals (CI) in patients in AKIN stage 1 compared with patients without AKI were 4.36 (95% CI: 2.83–6.71) for short-term mortality; 2.34 (1.43–3.82) for stroke; and 2.88 (1.84–4.50) for mediastinitis compared with patients without AKI.
Studies II-IV investigated associations between AKI and long-term risks for mortality, MI, stroke or ESRD in a nation-wide cohort of almost 30 000 patients who underwent first elective CABG, 13% of whom developed AKI postoperatively. Associations were seen between MI, mortality and AKI, with hazard ratios (HR) for MI and death increasing with AKI severity. Adjusted HR for patients with AKI stage 1 were 2.92 (95% CI: 1.87–4.55) for ESRD; 1.35 (95% CI: 1.15–1.57) for MI; and 1.30 (95% CI: 1.17–1.44) for all-cause mortality compared with patients without AKI. Although we found no association between AKI and long-term risk of stroke, a subgroup analysis showed an increased long-term risk for postoperative stroke among patients younger than 65 years.
In conclusion, AKI after CABG was associated with increased risks for postoperative death, stroke, and mediastinitis. AKI was also strongly associated with long-term mortality, MI and ESRD after CABG, but not with long-term risk of stroke.
Study I investigated the association between AKI after an initial isolated CABG and postoperative complications and death within 60 days of surgery. Of 7594 patients, 1047 (14%) patients developed AKI as defined by the Acute Kidney Injury Network (AKIN) classification. Patients with AKI had increased risk for death and postoperative complications. Multivariable adjusted odds ratios (OR) with 95% confidence intervals (CI) in patients in AKIN stage 1 compared with patients without AKI were 4.36 (95% CI: 2.83–6.71) for short-term mortality; 2.34 (1.43–3.82) for stroke; and 2.88 (1.84–4.50) for mediastinitis compared with patients without AKI.
Studies II-IV investigated associations between AKI and long-term risks for mortality, MI, stroke or ESRD in a nation-wide cohort of almost 30 000 patients who underwent first elective CABG, 13% of whom developed AKI postoperatively. Associations were seen between MI, mortality and AKI, with hazard ratios (HR) for MI and death increasing with AKI severity. Adjusted HR for patients with AKI stage 1 were 2.92 (95% CI: 1.87–4.55) for ESRD; 1.35 (95% CI: 1.15–1.57) for MI; and 1.30 (95% CI: 1.17–1.44) for all-cause mortality compared with patients without AKI. Although we found no association between AKI and long-term risk of stroke, a subgroup analysis showed an increased long-term risk for postoperative stroke among patients younger than 65 years.
In conclusion, AKI after CABG was associated with increased risks for postoperative death, stroke, and mediastinitis. AKI was also strongly associated with long-term mortality, MI and ESRD after CABG, but not with long-term risk of stroke.
List of papers:
I. Acute kidney injury following coronary artery bypass grafting: early mortality and postoperative complications. Linda Rydén, Staffan Ahnve, Max Bell, Niklas Hammar, Torbjörn Ivert, Martin J. Holzmann. Scandinavian Cardiovascular Journal, 2012;46:114–20.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Acute kidney injury after coronary artery bypass grafting and long-term risk of myocardial infarction and death. Linda Rydén, Staffan Ahnve, Max Bell, Niklas Hammar, Torbjörn Ivert, Ulrik Sartipy, Martin J. Holzmann. International Journal of Cardiology 2014;172:190-5.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Acute kidney injury and long-term risk of stroke after coronary artery bypass surgery. Martin J. Holzmann, Linda Rydén, Ulrik Sartipy. International Journal of Cardiology. 2013;168:5405-10.
Fulltext (DOI)
Pubmed
View record in Web of Science®
IV. Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease. Linda Rydén, Ulrik Sartipy, Marie Evans, Martin J. Holzmann Circulation. 2014;130:2005-11.
Fulltext (DOI)
Pubmed
View record in Web of Science®
I. Acute kidney injury following coronary artery bypass grafting: early mortality and postoperative complications. Linda Rydén, Staffan Ahnve, Max Bell, Niklas Hammar, Torbjörn Ivert, Martin J. Holzmann. Scandinavian Cardiovascular Journal, 2012;46:114–20.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Acute kidney injury after coronary artery bypass grafting and long-term risk of myocardial infarction and death. Linda Rydén, Staffan Ahnve, Max Bell, Niklas Hammar, Torbjörn Ivert, Ulrik Sartipy, Martin J. Holzmann. International Journal of Cardiology 2014;172:190-5.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Acute kidney injury and long-term risk of stroke after coronary artery bypass surgery. Martin J. Holzmann, Linda Rydén, Ulrik Sartipy. International Journal of Cardiology. 2013;168:5405-10.
Fulltext (DOI)
Pubmed
View record in Web of Science®
IV. Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease. Linda Rydén, Ulrik Sartipy, Marie Evans, Martin J. Holzmann Circulation. 2014;130:2005-11.
Fulltext (DOI)
Pubmed
View record in Web of Science®
Institution: Karolinska Institutet
Supervisor: Holzmann, Martin J.
Issue date: 2015-02-12
Rights:
Publication year: 2015
ISBN: 978-91-7549-777-8
Statistics
Total Visits
Views | |
---|---|
Acute ...(legacy) | 791 |
Acute ... | 316 |
Total Visits Per Month
October 2023 | November 2023 | December 2023 | January 2024 | February 2024 | March 2024 | April 2024 | |
---|---|---|---|---|---|---|---|
Acute ... | 2 | 4 | 2 | 5 | 0 | 3 | 0 |
File Visits
Views | |
---|---|
Thesis_Linda_Rydén.pdf(legacy) | 707 |
Thesis_Linda_Rydén.pdf | 298 |
Top country views
Views | |
---|---|
China | 285 |
United States | 166 |
Sweden | 140 |
Germany | 127 |
India | 25 |
France | 12 |
Bulgaria | 11 |
Egypt | 11 |
Ireland | 10 |
Finland | 6 |
Top cities views
Views | |
---|---|
Shenzhen | 196 |
Ashburn | 48 |
Kiez | 34 |
Sunnyvale | 27 |
Nürnberg | 25 |
Stockholm | 25 |
Beijing | 19 |
Dublin | 9 |
Plovdiv | 6 |
Woodbridge | 6 |