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

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 (AKI _SCr) and oliguria (AKI _UO) was observed in 9.7 % and 40.2 %, respectively. AKI patients had a significantly higher BMI and baseline SCr. In comparison to AKI _UO, AKI _SCr 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 AKI _SCr and AKI _UO 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.