الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 109 |  |  |
| | | from | 109 | | |
Abstract
Cardiac-surgery associated acute kidney injury (CSA-AKI) remains an important and frequent complication in patients undergoing cardiac surgery and is associated with a poor short- and long-term prognosis. The incidence for CSA-AKI according to Acute Kidney Injury Network criteria (AKIN) varies between 3% and 50%. CSA-AKI requiring temporary renal replacement therapy (RRT) occurs in 5% to 20% of these patients and is associated with a high mortality rate.
To decrease the incidence AKI after cardiac surgery, numerous interventions have been tested, but none has proved efficient. In the absence of proven interventions, a reasonable strategy would be to identify modifiable risk factors for AKI in this setting. These modifiable risk factors might serve as therapeutic targets for preventing AKI.
Previous studies have identified several important risk factors for AKI after cardiac surgery. Patient-related risk factors like female gender, chronic obstructive pulmonary disease, diabetes mellitus, peripheral vascular disease, renal insufficiency, congestive heart failure, left ventricular (LV) ejection fraction <35%, need for emergent surgery, cardiogenic shock requiring IABP, total circulatory arrest, left main coronary artery disease, etc., are the important factors associated with AKI-CS.
Risk factors pertaining to procedures that increase the likelihood of AKI-CS are the CPB machine, On-pump versus off-pump CABG, hemolysis, and hemodilution. Consequently, This study was undertaken to examine the prognostic importance of one of the most important modifiable intraoperative risk factor for AKI after cardiac surgery which is duration of the cardiopulmonary bypass time.
Unlike nephropathies that reflect a single source of insult (e.g. contrast-induced nephropathy), post-cardiac surgery AKI reflects the cumulative consequences of numerous potential perioperative factors (Mehta et al., 2007). One of the most important factors affecting perioperative renal function is the cardiopulmonary bypass which induce renal insult by several mechanisms.
Aim of the study:
The aim of this study was to detect the relation between prolonged cardiopulmonary bypass time in cardiac surgery and the incidence of post-operative acute kidney injury.
Type of the study: Observational retrospective study
Study setting: Aswan Heart centre (Magdi Yacoub Foundation)
Study period: 12 months
Study population: 80 patients, 40 in each group.
Inclusion criteria
1. Patients of either sex, aging from eighteen to sixty years
2. Patients underwent elective cardiac surgery in Aswan Heart Centre during the period from the 1st of January 2017 to the 30th of December 2017 and don’t have any of the following exclusion criteria.
Exclusion criteria
1. Emergent cardiac surgery.
2. Off-pump cardiac surgery.
3. Redo cardiac surgery.
4. Age <18 years old or > 60 years.
5. Patients who developed perioperative MI or cardiogenic shock or cardiac arrest.
6. Patients with chronic kidney disease on regular replacement therapy.
7. Preoperative estimated glomerular filtrations rate (e-GFR) <60 ml/min.
Grouping:
The patients were divided into two groups,
group (1): control group, patients underwent elective on-pump cardiac surgery and did not developed post-op AKI (40 patients).
group (2): patients underwent elective on-pump cardiac surgery and developed post-op AKI (40 patients).
According to Acute Kidney Injury Network (AKIN) criteria.
Data collection:
The following perioperative data were collected for the study purpose,
• Demographic characteristics: Age (in years), height (in cm), weight (in Kg), and sex.
• Medical history and comorbidities: Hypertension, diabetes mellitus, rheumatic heart disease, ischemic heart disease, hepatitis C virus and smoking history.
• Preoperative laboratory results: haemoglobin level, renal function tests, liver function tests, HbA1C and estimated glomerular filtration rate.
• Left ventricular Ejection Fraction obtained from the transesophageal echo which routinely performed before skin incision.
• Type of surgery.
• Cardiopulmonary bypass duration.
• Serum creatinine levels obtained at the following time points: (t1) at the day before surgery, (t2) at the end of surgical procedure and (t3, t4, t5) on the morning of the first to third postoperative day.
Results:
Results of the statistical analysis of the present study showed that mean CPB duration was prolonged in the AKI group of patients (155 min) than the non-AKI group of patients (129 min).
Conclusion:
Prolonged cardiopulmonary bypass duration may be an independent risk factor for acute kidney injury post cardiac surgery in adult patients.