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

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Total arch replacement (n=158). Intervention: Mild hypothermia or normothermia vs. Moderate hypothermia. Primary outcome: Acute kidney injury (KDIGO criteria) (p=0.83).

Hiroki Omiya; Makoto Takatori; Keiji Yunoki; Hiroshi Morimatsu

doi:10.18926/amo/62771

January 1, 2021Open Access

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

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Key result

Mild hypothermia or normothermia during cardiopulmonary bypass was not associated with a significant difference in the risk of acute kidney injury compared to moderate hypothermia (37.2% vs 41.9%).

Why the study?

Many patients develop acute kidney injury after vascular surgery, prompting investigation into risk factors after total arch replacement and the influence of temperature management during cardiopulmonary bypass.

Does mild hypothermia or normothermia compared to moderate hypothermia reduce acute kidney injury in patients undergoing total arch replacement?

Study Design

Type

Observational (n=158)

Multicenter

No

Structured PICO

Does mild hypothermia or normothermia compared to moderate hypothermia reduce acute kidney injury in patients undergoing total arch replacement?

P

Population

158 patients (mean age 66.9 years, 32.3% female) undergoing elective or emergent total arch replacement, evaluated for postoperative acute kidney injury.

E

Exposure

Mild hypothermia (core temperature 28.1-34°C) or normothermia (core temperature 34.1-36°C) during cardiopulmonary bypass

C

Comparator

Moderate hypothermia (core temperature 20.1-28°C) during cardiopulmonary bypass

O

Outcome

Postoperative acute kidney injury (AKI) defined by KDIGO criteria (increase in serum creatinine >50% of baseline within 7 days or increase of 0.3 mg/dL within 48 h)safety

Main Result

Absolute Event Rate: 37.2% vs 41.9%

p-value: p=0.83

Limitations

Single-center retrospective design with potential unmeasured confounding biases.
Small sample size after propensity score matching (43 patients per group), limiting statistical power.
Heterogeneous patient backgrounds and variations in surgical techniques for total arch replacement.
Inclusion of emergency cases where preoperative data collection and CT contrast use may have introduced bias.
Perioperative hemodynamic status was not considered in the analysis.
Significant difference in lower body ischemic time remained between groups even after propensity score matching.
Retrospective design
Single-center study
Urine output data not used for KDIGO criteria due to potential inaccuracy from confounding factors like diuretics

Implication

Modifiable risk factors for AKI after total arch replacement include prolonged cardiopulmonary bypass and lower body ischemic times, while temperature management during bypass does not significantly affect AKI risk.

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.

Discussion

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Cite This Study

Omiya et al. (2021) conducted an observational in Total arch replacement (n=158). Mild hypothermia or normothermia vs. Moderate hypothermia was evaluated on Acute kidney injury (KDIGO criteria) (p=0.83). Mild hypothermia or normothermia during cardiopulmonary bypass was not associated with a significant difference in the risk of acute kidney injury compared to moderate hypothermia (37.2% vs 41.9%).

synapsesocial.com/papers/6a9f556686aecf11c3083e93 https://doi.org/10.18926/amo/62771

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

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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