Introduction: Acute kidney injury (AKI), identified by elevated serum creatinine or reduced urine output, is a frequent complication following cardiac surgery. It is associated with hypoperfusion, embolic events, extracorporeal circulation–related injury, and nephrotoxic exposure, affecting up to 43% of adults and 52% of children. Methods: Adult patients undergoing cardiac surgery with extracorporeal circulation were included. AKI was defined according to KDIGO criteria (？SCr > 0.3 mg/dL within 48 h, >1.5 × baseline within 7 days, or urine output < 0.5 mL/kg/h for 6 h). Data were collected prospectively, and inferential analyses (AUROC, odds ratios, chi-square with p < 0.05) were performed using SPSS v24.0. Sampling was conducted by convenience. The study adhered to national and international research ethics guidelines, including the Mexican General Health Law on Research. Results: Forty adults underwent cardiopulmonary bypass (mean age 65.8 ± 9.9 years; 75% male), with no exclusions. Serum creatinine increased from 1.11 ± 0.38 mg/dL at baseline to 2.39 ± 1.16 mg/dL at 48 hours. AKI developed in 34 patients (85%), distributed as stage I: 7.5%, stage II: 17.5%, and stage III: 60%. Cardiac power demonstrated predictive capacity for AKI, though AUROC analysis indicated negligible performance (AUC 0.093, p = 0.002). Conclusions: In patients undergoing cardiac surgery with cardiopulmonary bypass, mean cardiac output at ICU admission was 3.01 ± 1.12 L/min with cardiac power (CP) of 0.51 ± 0.26 W. AKI occurred in 85% of patients, predominantly stage III. A CP below 0.46 W doubled the risk of AKI regardless of stage, although its AUROC-based predictive performance remained negligible despite statistical significance.
References
[1]
Yoon, S.Y., Kim, J.S., Jeong, K.H. and Kim, S.K. (2022) Acute Kidney Injury: Biomarker-Guided Diagnosis and Management. Medicina, 58, Article 340. https://doi.org/10.3390/medicina58030340
[2]
Thomas, M.E., Blaine, C., Dawnay, A., Devonald, M.A.J., Ftouh, S., Laing, C., et al. (2015) The Definition of Acute Kidney Injury and Its Use in Practice. Kidney International, 87, 62-73. https://doi.org/10.1038/ki.2014.328
[3]
Kellum, J.A. and Prowle, J.R. (2018) Paradigms of Acute Kidney Injury in the Intensive Care Setting. Nature Reviews Nephrology, 14, 217-230. https://doi.org/10.1038/nrneph.2017.184
[4]
Fuhrman, D.Y. and Kellum, J.A. (2017) Epidemiology and Pathophysiology of Cardiac Surgery-Associated Acute Kidney Injury. Current Opinion in Anaesthesiology, 30, 60-65. https://doi.org/10.1097/aco.0000000000000412
[5]
Scurt, F.G., Bose, K., Mertens, P.R., Chatzikyrkou, C. and Herzog, C. (2024) Cardiac Surgery–Associated Acute Kidney Injury. Kidney360, 5, 909-926. https://doi.org/10.34067/kid.0000000000000466
[6]
Sutherland, L., Hittesdorf, E., Yoh, N., Lai, T., Mechling, A. and Wagener, G. (2020) Acute Kidney Injury after Cardiac Surgery: A Comparison of Different Definitions. Nephrology, 25, 212-218. https://doi.org/10.1111/nep.13669
[7]
Mokhtar, A.T., Tennankore, K., Doucette, S. and Herman, C.R. (2021) Predicting Acute Kidney Injury Following Nonemergent Cardiac Surgery: A Preoperative Scorecard. Journal of Cardiac Surgery, 36, 2204-2212. https://doi.org/10.1111/jocs.15503
[8]
Pereira, M., Rodrigues, N., Godinho, I., Gameiro, J., Neves, M., Gouveia, J., et al. (2017) Acute Kidney Injury in Patients with Severe Sepsis or Septic Shock: A Comparison between the ‘risk, Injury, Failure, Loss of Kidney Function, End-Stage Kidney Disease’ (RIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) Classifications. Clinical Kidney Journal, 10, sfw107. https://doi.org/10.1093/ckj/sfw107
[9]
Yu, Y., Li, C., Zhu, S., Jin, L., Hu, Y., Ling, X., et al. (2023) Diagnosis, Pathophysiology and Preventive Strategies for Cardiac Surgery-Associated Acute Kidney Injury: A Narrative Review. European Journal of Medical Research, 28, Article No. 45. https://doi.org/10.1186/s40001-023-00990-2
[10]
Ostermann, M., Kunst, G., Baker, E., Weerapolchai, K. and Lumlertgul, N. (2021) Cardiac Surgery Associated AKI Prevention Strategies and Medical Treatment for CSA-AKI. Journal of Clinical Medicine, 10, Article 5285. https://doi.org/10.3390/jcm10225285
[11]
Massoth, C., Zarbock, A. and Meersch, M. (2021) Acute Kidney Injury in Cardiac Surgery. Critical Care Clinics, 37, 267-278. https://doi.org/10.1016/j.ccc.2020.11.009
[12]
Andersson, L.G., Bratteby, L.E., Ekroth, R., Hallhagen, S., Joachimsson, P.O., van der Linden, J., et al. (1994) Renal Function during Cardiopulmonary Bypass: Influence of Pump Flow and Systemic Blood Pressure. EuropeanJournalofCardio-ThoracicSurgery, 8, 597-602. https://doi.org/10.1016/1010-7940(94)90043-4
[13]
Sgouralis, I., Evans, R.G., Gardiner, B.S., Smith, J.A., Fry, B.C. and Layton, A.T. (2015) Renal Hemodynamics, Function, and Oxygenation during Cardiac Surgery Performed on Cardiopulmonary Bypass: A Modeling Study. Physiological Reports, 3, e12260. https://doi.org/10.14814/phy2.12260
[14]
Clifford, K.M., Selby, A.R., Reveles, K.R., Teng, C., Hall, R.G., McCarrell, J., et al. (2022) The Risk and Clinical Implications of Antibiotic-Associated Acute Kidney Injury: A Review of the Clinical Data for Agents with Signals from the Food and Drug Administration’s Adverse Event Reporting System (FAERS) Database. Antibiotics, 11, Article 1367. https://doi.org/10.3390/antibiotics11101367
[15]
Silverton, N.A., Lofgren, L.R., Hall, I.E., Stoddard, G.J., Melendez, N.P., Van Tienderen, M., et al. (2021) Noninvasive Urine Oxygen Monitoring and the Risk of Acute Kidney Injury in Cardiac Surgery. Anesthesiology, 135, 406-418. https://doi.org/10.1097/aln.0000000000003663
[16]
Billings, F.T. (2019) Acute Kidney Injury Following Cardiac Surgery: A Clinical Model. Nephron, 143, 202-206.
[17]
Jacob, K.A. and Leaf, D.E. (2019) Prevention of Cardiac Surgery-Associated Acute Kidney Injury: A Review of Current Strategies. Anesthesiology Clinics, 37, 729-749. https://doi.org/10.1016/j.anclin.2019.08.007
Prowle, J.R. and Kirwan, C.J. (2014) Acute Kidney Injury after Cardiac Surgery: The Injury That Keeps on Hurting. Critical Care Medicine, 42, 2142-2143. https://doi.org/10.1097/ccm.0000000000000453
[20]
Liu, K.D., Thompson, B.T., Ancukiewicz, M., Steingrub, J.S., Douglas, I.S., Matthay, M.A., et al. (2011) Acute Kidney Injury in Patients with Acute Lung Injury: Impact of Fluid Accumulation on Classification of Acute Kidney Injury and Associated Outcomes. Critical Care Medicine, 39, 2665-2671. https://doi.org/10.1097/ccm.0b013e318228234b
[21]
Yuan, S.M. (2019) Acute Kidney Injury after Cardiac Surgery: Risk Factors and Novel Biomarkers. BrazilianJournalofCardiovascularSurgery, 34, 352-360. https://doi.org/10.21470/1678-9741-2018-0212
[22]
Popovic, B., Fay, R., Cravoisy-Popovic, A. and Levy, B. (2014) Cardiac Power Index, Mean Arterial Pressure, and Simplified Acute Physiology Score II Are Strong Predictors of Survival and Response to Revascularization in Cardiogenic Shock. Shock, 42, 22-26. https://doi.org/10.1097/shk.0000000000000170
[23]
Fincke, R., Hochman, J.S. and Lowe, A.M. (2004) Cardiac Power Is the Strongest Hemodynamic Correlate of Mortality in Cardiogenic Shock: A Report from the Shock Trial Registry. ACC Current Journal Review, 13, 49. https://doi.org/10.1016/j.accreview.2004.10.045
[24]
Khoury, J., Arow, M., Elias, A., Makhoul, B.F., Berger, G., Kaplan, M., et al. (2017) The Prognostic Value of Brain Natriuretic Peptide (BNP) in Non-Cardiac Patients with Sepsis, Ultra-Long Follow-Up. Journal of Critical Care, 42, 117-122. https://doi.org/10.1016/j.jcrc.2017.07.009
[25]
Hall, S.G., Garcia, J., Larson, D.F. and Smith, R. (2012) Cardiac Power Index: Staging Heart Failure for Mechanical Circulatory Support. Perfusion, 27, 456-461. https://doi.org/10.1177/0267659112450933
[26]
Herrera, L., Valenzuela, E., González Pacheco, E., Velasco, H., Arias Mendoza, B.M. and Sánchez, A. (2006) El poder cardíaco un instrumento del pasado, posiblemente una herramienta moderna en la valoración: Clínica, terapéutica y pronóstica del choque cardiogénico por síndrome isquémico coronario agudo. Archivos de cardiología de México, 76, 95-108.
[27]
Hothi, S.S., Tan, L.B. and Cotter, G. (2015) Resting Cardiac Power Index and Prediction of Prognosis in Heart Failure: Invited Editorial. EuropeanJournalofHeartFailure, 17, 642-644. https://doi.org/10.1002/ejhf.310
[28]
Zepeda, E.M., Zamora, M.A., Castrillo, C.S., Espinoza, V.C., et al. (2008) Delta de poder cardiaco en choque séptico. Medicina Crítica, 22, 15-19.
