Duration of Critically Low Oxygen Delivery is Associated With Acute Kidney Injury After Cardiac Surgery

Acta Anaesthesiol Scand. 2019 Aug 22. [Epub ahead of print]

Acute kidney injury is a serious complication following cardiac surgery associated with mortality. Restricted oxygen delivery is a potential risk factor for acute kidney injury. The aim of this study was to investigate the impact of the duration of low oxygen delivery (<272 mL. min−1.m−2), during cardiopulmonary bypass on kidney function.

Background

Acute kidney injury is a serious complication following cardiac surgery associated with mortality. Restricted oxygen delivery is a potential risk factor for acute kidney injury. The aim of this study was to investigate the impact of the duration of low oxygen delivery (<272 mL. min−1.m−2), during cardiopulmonary bypass on kidney function.

Methods

Patients undergoing coronary artery bypass graft surgery ± valve repair were included n=1968. Oxygen delivery was monitored during cardiopulmonary bypass. Data were explored using multiple regression analyses regarding association between low oxygen delivery and renal replacement therapy (RRT), acute kidney injury (AKI) and postoperative peak serum creatinine (PPSC).

Results

Postoperative peak serum creatinine, incidence of acute kidney injury, and need for dialysis increased in a dose‐dependent manner in relation to duration of a mean oxygen delivery <272 mL. min−1.m−2. Using multiple regression analyses only exposure for at least 30 minutes was independently associated with increased PPSC and AKI. In contrast, both short (1‐5 min, OR: 2.58 [1.20, 5.54]; p=0.015) and at least 30 min (OR: 2.85 [1.27‐6.41]; p=0.011) exposure to low DO2 were both independently associated with the need for RRT.

Conclusion

A low oxygen delivery during cardiopulmonary bypass was in a dose‐dependent manner associated with an increased risk of renal injury.