Incidence of acute kidney injury in obese patients undergoing cardiac surgery.
PDF (Español (España))
HTML (Español (España))

Keywords

Obesity
cardiac surgical procedures
acute kidney injury
critical care

Categories

How to Cite

1.
Urquhart A, Peralta A, Pederzani M, Ferreira F, Figueredo B, Blanco H. Incidence of acute kidney injury in obese patients undergoing cardiac surgery. Rev Arg de Ter Int. [Internet]. 2022 Jan. 12 [cited 2024 Jul. 3];39. Available from: https://revista.sati.org.ar/index.php/MI/article/view/800

Abstract

OBJECTIVE: To determine the incidence of acute renal injury in obese patients undergoing Cardiac Surgery in the Adult Intensive Care Unit (ICU) at the Clinical Hospital.

DESIGN: retrospective cohort.

PARTICIPANTS AND INCLUSION CRITERIA: Patients older than 18 years undergoing any cardiac surgery, admitted to the ICU in the period of time between 2016 and 2019. A total of 77 patients were recruited consecutively, matched 16/53 (exposed / not exposed).

No interventions were performed.

OUTCOMES: incidence of acute renal injury in obese patients, days of hospitalization, days of mechanical ventilation, frequency of tracheostomy, frequency of Acute Renal Injury and staging of Kidney Disease: Improving Global Outcomes (KDIGO), frequency of requirement of renal replacement therapy, mortality.

RESULTS: 66% male. The mean age of the sample was 54.12 ± 16.07. The baseline variables for the obese / non-obese cohorts were similar in both groups. Myocardial revascularization surgery was the most prevalent. The frequency of obese patients is 24 patients (31%). The frequency of acute kidney injury in the general population 62%. The incidence of acute kidney injury in the obese population was 79% with RR: 1.44, p <0.05. The outcomes: hospitalization days, ventilator days, hemodialysis, tracheostomy and mortality were more frequent in the obese group.

CONCLUSIONS: The incidence of acute kidney injury in the obese cohort was 79%, most of them KDIGO stage 3. All adverse secondary outcomes (except frequency of KDIGO stage 1) are more frequent in the obese population undergoing cardiac surgery.

Key words: obesity, cardiac surgical procedures, acute kidney injury, critical care.

PDF (Español (España))
HTML (Español (España))

References

1. Organización Mundial de la Salud [Sede Web]. Ginebra: OMS; 2019[acceso 5 de mayo de 2019]. Centro de prensa. Obesidad y Sobrepeso. Disponible en: http://www.who.int/mediacentre/factsheets/fs311/es/

2. Organización Panamericana de la Salud [Sede Web]. Chile: OPS, 2019[acceso 5 de mayo de 2019]. Notas de primera página. Representación en Chile. Obesidad. Disponible en: http://www.paho.org/chi/index.php?option=com_content&view=article&id=179:obesidad&Itemid=1005.

3. World Health Organization. Obesity: Preventing and Managing the Global Epidemic: Report on a WHO Consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii,1–253.

4. Ministerio de Salud Pública y Bienestar Social[Sede Web]. Asunción: MSPyBS, 2019[acceso 10 de octubre de 2019]. Portal. Día nacional contra la obesidad. Disponible en: https://www.mspbs.gov.py/portal/16292/dia-nacional-contra-la-obesidad-2-de-cada-3-paraguayos-tiene-exceso-de-peso.html.

5. Goiburu ME, Zelaya V, Alé L, Figueredo C, Peralta A, Bianco H. Prevalence of Obesity and its Relationship with the Outcome in critical patients. Clinical Nutrition. 2014; 33:139-140.
6. Tjeertes, E., Hoeks, S., Beks, S., Valentijn, T.,. and Stolker, R. J; Obesity – a risk factor for postoperative complications in general surgery? BMC Anesthesiology; 2015.
7. Fernandez-Bustamante, A., Hashimoto, S., Serpa Neto, A. and Repine, J.; Perioperative lung protective ventilation in obese patients; BMC Anesthesiology; 2015.
8. Braun, N., Gomes, F., Schuetz, P., “The obesity paradox” in disease – is the protective effect of obesity true? Swiss Med. Wkly.; 2015.
9. Carnethon, M.; and Khan; S.; An apparent obesity paradox in cardiac surgery; Circulation; 2017.
10. Kuperman, E., Showalter, J., Lehman, E., Leib, A. and Kraschnewski, J., The impact of obesity on sepsis mortality: a retrospective review, BMC Infectious Diseases; 2013.
11. Danziger, J.; Chen K.; Lee J.; Obesity, Acute Kidney Injury, and Mortality in Critical Illness; Critical Care Med.; 2016.
12. MeganChacon, M.; Cheruku, S.; Neuburger, P.; Perioperative Care of the Obese Cardiac Surgical Patient; J. of Cardiothorac. and Vasc. An.; 2018
13. Stamou, S.; Nussbaum, M.; Stiegel, R.; et al; Effect of Body Mass Index on Outcomes After Cardiac Surgery: Is There an Obesity Paradox? Ann. Thorac. Surg.; 2011.
14. Nieto-Ríos, J.; Bello, D.; Lesión Renal Aguda 2018; 2018. Disponible en: https://www.researchgate.net/publication/324243772
15. Eknoyan G, Lameire N. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl.2012.
16. Pavlakou, P; Liakopoulos, V.; Oxidative Stress and Acute Kidney Injury in Critical Illness:Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives; Oxidative Medicine and Cellular Longevity; 2017.
17. Poston, J.; Koyner, J.; Sepsis associated acute kidney injury: State of the art review; BMJ; 2019.
18. Peerapornratana, S.; Manrique-Caballero, C.; Gómez, H.; Kellum, J.; Acutekidney injury from sepsis: current concepts,epidemiology, pathophysiology, prevention and treatment; Kidney International; 2019.
19. Boltansky, A.; Bassa, C.;, Melani, S.; , Sepúlveda, A;, Maldonado, I. y col; Incidencia de lainjuria renal aguda en unidad de paciente crítico y sumortalidad a 30 días y un año; Rev Med Chile; 2015.
20. Thiele, R.; James, I.; and Mitchell, R.; AKI Associated with Cardiac Surgery; Clin J Am Soc Nephrol.; 2015.
21. Wang, Y.; Bellomo, R.; Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment; Nature Reviews: Neprhology; 2017.
22. Himmelfarb, J.; et al; Perioperative THR-184 and AKI after Cardiac Surgery; J. Am. Soc. Nephrol.; 2017.
23. Englberger, L., et al; Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery; Critical Care; 2011.
24. Schmidt, D., Gomes de Araújo, T., Coelho, A.; Critically ill obese patients: a challenge in weaning from invasive mechanical ventilation; Revista HCPA.; 2012.
25. Wardell, S. MD, Wall, A. MD, Reid, J. K. MD; The association between obesity and outcomes in critically ill patients; Can. Respir. J.; 2015.
26. Danziger, J. MD; Chen K., MD; Lee J., PhD; Obesity, Acute Kidney Injury, and Mortality in Critical Illness; Critical Care Med.; 2016.
27. Pepper, D. J.; Demirkale, C. Y.; Sun, J.; Rhee, Kadri, S.; Does Obesity Protect Against Death in Sepsis? A Retrospective Cohort Study of 55,038 Adult Patients; Critical Care Medicine; 2019.
28. Vargo, P.; Steffen, R.; Bakaeen, F.; Navale, S.; The impact of obesity on cardiac surgery outcomes; J. Card. Surg.; 2018.
29. Hysia, I; Pincon, C.; Guesnier, L; Gautier, L; et al; Results of elective cardiac surgery in patients with severe obesity (body mass index ≥ 35 kg/m2); Archives of Cardiovascular Disease; 2014.
30. Ghanta, R.; LaPar, D.; et al; Obesity Increases Risk-Adjusted Morbidity, Mortality, and Cost Following Cardiac Surgery; J. Am. Heart Assoc.; 2017.
31. O’Sullivan, K.; Byrne, J.;Hudson, A.; et al; The effect of obesity on acute kidney injury after cardiac surgery; J. Thorac. Cardiovasc. Surg.; 2015.
32. Mariscalco, G.; Wozniak, M.; Dawson, A., et al; Body-Mass Index and Mortality Among Adults Undergoing Cardiac Surgery:A Nationwide Study with a Systematic Review and Meta-Analysis; Circul. AHA. J.; 2016.
33. Lau, G.; Wald, R.; Sladen, R.; et al; Acute Kidney Injury in Cardiac Surgery and Cardiac Intensive Care; Semin. in Cardiothor. and Vasc. Anest.; 2015.
34. Rodríguez-Hernández, A.; García-Torres, M.; Bucio Reta, E.; y Francisco Baranda-Tovar, M.; Análisis de mortalidad y estancia hospitalaria en cirugía cardiaca en México 2015: datos del Instituto Nacional de Cardiología; Arch. Cardiol. Mex.; 2018.

The magazine does not retain the reproduction rights (copyright) so the authors can republish their works with the sole mention of the original publication source.