Peri-operative interventions, but not inflammatory mediators, increase risk of acute kidney injury after cardiac surgery: A prospective cohort study

Journal article

Purpose: Cardiopulmonary bypass (CPB)-related inflammatory response might be one mechanism by which cardiac surgery associated acute kidney injury (CS-AKI) occurs. Interventions that may attenuate inflammation, including glucocorticoids or phosphodiesterase inhibitors, could therefore have a role in its prevention. We aimed to determine the role of inflammatory mediators in CS-AKI in children and the efficacy of commonly used peri-operative interventions to reduce CS-AKI risk. Methods: We prospectively studied 109 children undergoing heart surgery. Using regression modeling (adjusting for covariates), we (1) evaluated the association between inflammatory mediators [interleukin (IL)-6, IL-8, C-reactive protein, and tumor necrosis factor-α levels] and CS-AKI, and (2) evaluated risk/prevention factors for CS-AKI including glucocorticoid and milrinone administration. CS-AKI was defined based on pRIFLE methods. Results: CS-AKI occurred in 68 % of children. No inflammatory mediator measured had an independent association with CS-AKI. Higher pre-operative glomerular filtration rate (GFR), sustained decrease in mean arterial pressure during CPB, post-operative single ventricle physiology, deep hypothermic circulatory arrest, and milrinone use at 24 h post-operatively were significant independent predictors of CS-AKI. Intra-operative steroid administration had no effect on the rate of CS-AKI. Conclusions: Although inflammatory mediators are up-regulated following CPB, we found no association between levels of inflammatory cytokines and CS-AKI. CS-AKI has complex pathophysiology and the observation that milrinone was associated with increased AKI risk (and that higher GFR predicts more injury) suggests that mechanisms beyond inflammation play a significant role. Intra-operative administration of glucocorticoid does not appear to be an effective intervention for reducing the risk of CS-AKI. © 2013 Springer-Verlag Berlin Heidelberg and ESICM.

Authors: Morgan, C; Gill, P; Lam, S; Joffe, A

• Journal: Intensive Care Medicine
• Volume: 39
• Issue: 5
• Pages: 934-941
• Publication date: 2013-05-01
• DOI: 10.1007/s00134-013-2849-4
• EISSN: 1432-1238
• ISSN: 0342-4642
• Language: English
• Keywords: Cardiac surgery; Children; Acute kidney injury; Inflammation; Milrinone