Clinical characteristics and risk factors of cardiac surgery associated-acute kidney injury progressed to chronic kidney disease in adults: A retrospective, observational cohort study

Xiaoguang Fan; Zehua Shao; Suhua Gao; Zhenzhen You; Shuai Huo; Zhu Zhang; Qiuhong Li; Saijun Zhou; Lei Yan; Fengmin Shao; Pei Yu

doi:10.3389/fcvm.2023.1108538

Clinical characteristics and risk factors of cardiac surgery associated-acute kidney injury progressed to chronic kidney disease in adults: A retrospective, observational cohort study

Front Cardiovasc Med. 2023 Mar 8:10:1108538. doi: 10.3389/fcvm.2023.1108538. eCollection 2023.

Authors

Xiaoguang Fan^{1

2

3}, Zehua Shao⁴, Suhua Gao^{1

2

5}, Zhenzhen You³, Shuai Huo³, Zhu Zhang³, Qiuhong Li^{1

2}, Saijun Zhou^{1

2}, Lei Yan⁵, Fengmin Shao⁵, Pei Yu^{1

2}

Affiliations

¹ NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
² Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, China.
³ Department of Nephrology, Henan Provincial People's Hospital, Department of Nephrology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.
⁵ Department of Nephrology, Henan Provincial People's Hospital, Henan Key Laboratory for Renal Immunity, People's Hospital of Zhengzhou University, Zhengzhou, China.

Abstract

Introduction: To retrospectively investigate the clinical characteristics and risk factors of cardiac surgery associated-acute kidney injury (CS-AKI) progressed to chronic kidney disease (CKD) in adults and to evaluate the performance of clinical risk factor model for predicting CS-AKI to CKD.

Methods: In this retrospective, observational cohort study, we included patients who were hospitalized for CS-AKI without a prior CKD [estimated glomerular filtration rate (eGFR) < 60 ml · min^-1·1.73 m^-2] at Central China Fuwai Hospital from January 2018 to December 2020. Survived patients were followed up for 90 days, the endpoint was CS-AKI to CKD, and then divided them into two groups (with or without CS-AKI to CKD). The baseline data including demographics, comorbidities, renal function, and other laboratory parameters were compared between two groups. The logistic regression model was used to analyze the risk factors for CS-AKI to CKD. Finally, receiver operator characteristic (ROC) curve was drawn to evaluate the performance of the clinical risk factor model for predicting CS-AKI to CKD.

Results: We included 564 patients with CS-AKI (414 males, 150 females; age: 57.55 ± 11.86 years); 108 (19.1%) patients progressed to new-onset CKD 90 days after CS-AKI. Patients with CS-AKI to CKD had a higher proportion of females, hypertension, diabetes, congestive heart failure, coronary heart disease, low baseline eGFR and hemoglobin level, higher serum creatinine level at discharge (P < 0.05) than those without CS-AKI to CKD. Multivariate logistic regression analysis revealed that female sex(OR = 3.478, 95% CI: 1.844-6.559, P = 0.000), hypertension (OR = 1.835, 95% CI: 1.046-3.220, P = 0.034), coronary heart disease (OR = 1.779, 95% CI: 1.015-3.118, P = 0.044), congestive heart failure (OR = 1.908, 95% CI: 1.124-3.239, P = 0.017), preoperative low baseline eGFR (OR = 0.956, 95% CI: 0.938-0.975, P = 0.000), and higher serum creatinine level at discharge (OR = 1.109, 95% CI: 1.014-1.024, P = 0.000) were independent risk factors for CS-AKI to CKD. The clinical risk prediction model including female sex, hypertension, coronary heart disease, congestive heart failure, preoperative low baseline eGFR, and higher serum creatinine level at discharge produced a moderate performance for predicting CS-AKI to CKD (area under ROC curve = 0.859, 95% CI: 0.823-0.896).

Conclusion: Patients with CS-AKI are at high risk for new-onset CKD. Female sex, comorbidities, and eGFR can help identify patients with a high risk for CS-AKI to CKD.

Keywords: cardiac surgery associated-acute kidney injury; chronic kidney disease; clinical characteristics; prediction; risk factors.

Grants and funding

This work was supported by Tianjin Key Medical Discipline (Specialty) Construct Project (No. TJYXZDXK-032A), Henan Provincial Health Commission Scientific Research Fund Project (No. 224000510005), and Henan Provincial Health Commission Medical Science and Technology Research (No. LHGJ20220116).