Background: Acute kidney injury (AKI) is a severe common postoperative complication
of cardiac surgery (CS). It increases the risk of mortality by up to 80%.
Therefore, it is essential to have preoperative risk evaluation tools. Frailty
is a marker of deterioration of physiologic systems and may be associated with
AKI. Purpose: The study aimed to determine the utility of frailty as a
predictor of AKI after CS. Method:We enrolled 91 patients undergoing CS with cardiopulmonary bypass to
determine if they had frailty before surgery and were associated with
postoperative AKI. The diagnosis of postoperative AKI was based on the serum
creatinine criteria of the Acute Kidney Injury Network classification up to 7
days following CS. Results: The incidence of postoperative AKI was 62%
in the frail group and 21% in the non-frail group. Frailty was associated with
a higher risk of AKI (relative risk [RR]=3.00,
95% CI 1.56-5.77, p=0.00).
In regression models, there were associations between frailty and postoperative
AKI. Conclusion: This study demonstrated that frailty could be a
predictor for post-CS
References
[1]
Nadim, M.K., Forni, L.G., Bihorac, A., Hobson, C., Koyner, J.L., Shaw, A., et al. (2018) Cardiac and Vascular Surgery-Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group. Journal of the American Heart Association, 7, e008834. https://doi.org/10.1161/JAHA.118.008834
[2]
Thakar, C.V., Arrigain, S., Worley, S., Yared, J.P. and Paganini, E.P. (2005) A Clinical Score to Predict Acute Renal Failure after Cardiac Surgery. Journal of the American Society of Nephrology, 16, 162-170. https://doi.org/10.1681/ASN.2004040331
[3]
Wang, Y. and Bellomo, R. (2017) Cardiac Surgery-Associated Acute Kidney Injury Risk, Factors, Pathophysiology, and Treatment. Nature Reviews, 13, 697-711. https://doi.org/10.1038/nrneph.2017.119
[4]
Akhtar, S. (2015) Preventing Adverse Outcomes in the Very Elderly Cardiac Surgical Patients. Journal of Cardiothoracic and Vascular Anesthesia, 29, 510-521. https://doi.org/10.1053/j.jvca.2014.07.014
[5]
Kiers, H.D., Van den Boogard, M., Schoenmakers, M.C., Van der Hoeve, J.G., Van Swieten, H.A., Heemskerk, S., et al. (2013) Comparison and Clinical Suitability of Eight Prediction Models for Cardiac Surgery-Related Acute Kidney Injury. Nephrology Dialysis Transplantation, 28, 345-351. https://doi.org/10.1093/ndt/gfs518
[6]
Rao, S.N., Shenoy, P. and Gopalakrishnan, M. (2018) Applicability of the Cleveland Clinic Scoring System for the Risk Prediction of Acute Kidney Injury after Cardiac Surgery in a South Asian Cohort. Indian Heart Journal, 70, 533-540. https://doi.org/10.1016/j.ihj.2017.11.022
[7]
Wittlinger, T., Maus, M., Kutschka, I., Baraki, H. and Friedrich, M.G. (2021) Identification of Risk Factors for Renal Failure after Cardiac Surgery by RFILE Classification. American Journal of Cardiovascular Disease, 11, 155-163.
[8]
Lannemyr, L., Bragadottir, G., Krumbholz, V., Redfors, B., Sellgren, J. and Ricksten, S.E. (2017) Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration and Oxygenation in Patients Undergoing Cardiac Surgery. Anesthesiology, 126, 205-218. https://doi.org/10.1097/ALN.0000000000001461
[9]
Zhang, W.R., Garg, A.X., Coca, S.G., Devereaux, P.J., Eikelboom, J., Kavsak, P., et al. (2015) Plasma IL-6 and IL-10 Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery. Journal of the American Society of Nephrology, 26, 123-132. https://doi.org/10.1681/ASN.2014080764
[10]
Koh, L.Y. and Hwang, N.C. (2019) Frailty in Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 33, 521-531. https://doi.org/10.1053/j.jvca.2018.02.032
[11]
Kim, S. and Jazwinski, S.M. (2015) Quantitative Measures of Healthy Aging and Biological Age. Healthy Aging Research, 4, Article No.26.
[12]
Fukui, S., Kawakami, M., Otaka, Y., Ishikawa, A., Mizuno, K., Tsuji, T., et al. (2016) Physical Frailty in Older People with Severe Aortic Stenosis. Aging Clinical and Experimental Research, 28, 1081-1088. https://doi.org/10.1007/s40520-015-0507-0
[13]
Kim, S., Jung, H., Kim, K., Hwang, D.W., Kang, S. and Kim, C. (2014) Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA Surgery, 149, 633-640. https://doi.org/10.1001/jamasurg.2014.241
[14]
Baek, S.H., Lee, S.W., Kim, S., Ahn, S.Y., Yu, M., Kim, K., et al. (2016) Frailty as a Predictor of Acute Kidney Injury in Hospitalized Elderly Patients: A Single Center, Retrospective Cohort Study. PLOS ONE, 11, e0156444. https://doi.org/10.1371/journal.pone.0156444
[15]
Abdel-Kader, K., Girard, T.D., Brummel, N.E., Saunders, C.T., Jeffrey, D.B., Amanda, J.C., et al. (2018) Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis. Critical Care Medicine, 46, e380. https://doi.org/10.1097/CCM.0000000000003003
[16]
Lee, D.H., Buth, K.J., Martin, B., Yip, A.M., Hirsch, G.M., et al. (2010) Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care after Cardiac Surgery. Circulation, 121, 973-978. https://doi.org/10.1161/CIRCULATIONAHA.108.841437
[17]
Von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., Gøtzsche, P.C. and Vandenbroucke, J.P. (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Bulletin of the World Health Organization, 85, 867-872. https://doi.org/10.2471/BLT.07.045120
[18]
Lancaster, G.A., Dodd, S. and Williamson, P.R. (2004) Design and Analysis of Pilot Studies: Recommendations for Good Practice. Journal of Evaluation in Clinical Practice, 10, 307-312. https://doi.org/10.1111/j..2002.384.doc.x
[19]
Fried, L.P., Tangen, C.M., Walston, J., Newman, A, B., Hirsch, C., Gottdiener, J., et al. (2001) Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56, 146-157. https://doi.org/10.1093/gerona/56.3.M146
[20]
Drey, M., Pfeifer, K., Sieber, C.C. and Bauer, J.M. (2011) The Fried Frailty Criteria as Inclusion Criteria for a Randomized Controlled Trial: Personal Experience and Literature Review. Gerontology, 57, 11-19. https://doi.org/10.1159/000313433
[21]
Mehta, R.L., Kellum, J.A., Shah, S.V., Molitoris, B.A., Ronco, C., Warnock, D.G., et al. (2007) Acute Kidney Injury Network: Report of an Initiative to Improve Outcomes in Acute Kidney Injury. Critical Care, 11, Article No. R31. https://doi.org/10.1186/cc5713
[22]
Li, Q., Zhao, M. and Zhou, F. (2020) Hospital-Acquired Acute Kidney Injury in very Elderly Men: Clinical Characteristics and Short-Term Outcomes. Aging Clinical and Experimental Research, 32, 1121-1129. https://doi.org/10.1007/s40520-019-01196-5
[23]
Morton, S., Isted, A., Avery, P. and Wang, J. (2019) Frailty and Acute Kidney Injury: A 1-Year Follow-Up of a Prospective Cohort. Journal of General Internal Medicine, 34, 1390-1391. https://doi.org/10.1007/s11606-019-04986-9
[24]
O’Neal, J.B., Shaw, A.D. and Billings, F.T. (2016) Acute Kidney Injury Following Cardiac Surgery: Current Understanding and Future Directions. Critical Care, 20, Article No. 187. https://doi.org/10.1186/s13054-016-1352-z
[25]
Shroyer, A.L., Grover, F.L., Hattler, B., Collins, J.F., McDonald, G.O., Kozora, E., et al. (2009) On-Pump versus Off-Pump Coronary-Artery Bypass Surgery. New England Journal of Medicine, 361, 1827-1837. https://doi.org/10.1056/NEJMoa0902905
[26]
Lamy, A., Devereaux, P., Prabhakaran, D., Taggart, D.P., Hu, S., Strak, Z., et al. (2016) Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. New England Journal of Medicine, 375, 2359-2368. https://doi.org/10.1056/NEJMoa1601564
[27]
Soysal, P., Stubbs, B., Lucato, P., et al. (2016) Inflammation and Frailty in the Elderly: A Systematic Review and Meta-Analysis. Ageing Research Reviews, 31, 1-8. https://doi.org/10.1016/j.arr.2016.08.006
[28]
Yang, Y., Hao, Q., Flaherty, J.H., Cao, L., Zhou, J., Su, L., et al. (2018) Comparison of Procalcitonin, a Potentially New Inflammatory Biomarker of Frailty, to Interleukin-6 and C-Reactive Protein among Older Chinese Hospitalized Patients. Aging Clinical and Experimental Research, 30, 1459-1464. https://doi.org/10.1007/s40520-018-0964-3
[29]
Williams, F.R., Vallance, A., Faulkner, T., Towey, J., Kyte, D., Durman, S., et al. (2018) Home-Based Exercise Therapy in Patients Awaiting Liver Transplantation: Protocol for an Observational Feasibility Trial. BMJ Open, 8, e019298.
[30]
Rabb, H., Griffin, M.D., McKay, D.B., Swaminathan, S., Pickers, P., Rosner, M.H., et al. (2016) Inflammation in AKI: Current Understanding, Essential Questions, and Knowledge Gaps. Journal of the American Society of Nephrology, 27, 371-379. https://doi.org/10.1681/ASN.2015030261
[31]
Wynter-Blyth, V. and Moorthy, K. (2017) Prehabilitation: Preparing Patients for Surgery. British Medical Journal, 358, 3702-3703. https://doi.org/10.1136/bmj.j3702
[32]
Ng, T.P., Feng, L., Nyunt, M.S.Z., Feng, L., Niti, M., Yeow, T., et al. (2015) Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal among Older Adults: A Randomized Controlled Trial. The American Journal of Medicine, 128, 1225-1236. https://doi.org/10.1016/j.amjmed.2015.06.017
