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. 2015 May 30:16:76.
doi: 10.1186/s12882-015-0066-9.

Incidence and outcomes of acute kidney injury after cardiac surgery using either criteria of the RIFLE classification

Marc-Gilbert Lagny  1 , François Jouret  2 , Jean-Noël Koch  3 , Francine Blaffart  4 , Anne-Françoise Donneau  5 , Adelin Albert  6 , Laurence Roediger  7 , Jean-Marie Krzesinski  8 , Jean-Olivier Defraigne  9
Affiliations

Incidence and outcomes of acute kidney injury after cardiac surgery using either criteria of the RIFLE classification

Marc-Gilbert Lagny et al. BMC Nephrol. .

Abstract

Background: Adult cardiac surgery is significantly associated with the development of acute kidney injury (AKI). Still, the incidence and outcomes of AKI vary according to its definition. Our retrospective monocentric study comparatively investigates the yield of RIFLE definition, which is based on the elevation of serum creatinine levels (SCr) or the reduction of urine output (UO), taking into account only one or both criteria. Pre- and per-operative risk factors for post-operative AKI were evaluated.

Methods: All adult patients undergoing cardiac surgery, with or without cardiopulmonary bypass, from April 2008 to March 2009 were included. Clinical, biological and surgical features were recorded. Baseline serum creatinine was determined as its value on day 7 before surgery. Post-operative AKI was diagnosed and scored based upon the highest serum creatinine and/or the lowest urine output.

Results: 443 patients (Male/Female ratio, 2.3; median age, 69y) were included, with 221 (49.9%) developing postoperative AKI. Elevated serum creatinine (AKISCr) and oliguria (AKIUO) was observed in 9.7% and 40.2%, respectively. AKI patients had a significantly higher BMI and baseline SCr. In comparison to AKIUO, AKISCr mostly occurred in patients with co-morbidities, and was associated with an increased mortality at 1-year post surgery.

Conclusions: The use of standard RIFLE definition of AKI in a cohort of 443 patients undergoing cardiac surgery resulted in an incidence reaching 50%. Still, significant discrepancies were found between AKISCr and AKIUO regarding the incidence and outcomes. In line with previous reports, our data questions the utility of urine output as a criterion for AKI diagnosis and management after cardiac surgery.

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Figures

Fig. 1
Fig. 1
Survival post cardiac surgery according to acute kidney injury severity. Kaplan-Meier survival curve post cardiac surgery in patients with increasing RIFLE stages of acute kidney injury on the basis of elevated serum creatinine (SCr) or decreased urine output (UO)
Fig. 2
Fig. 2
Survival post cardiac surgery according to AKI status. Kaplan-Meier survival curve post cardiac surgery in patients with no acute kidney injury (AKI, blue line), AKI with elevated serum creatinine (SCr, dotted red line) and AKI with decreased urine output (UO, dotted green line)
See this image and copyright information in PMC

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