PMID- 34327740
OWN - NLM
STAT- MEDLINE
DCOM- 20210913
LR  - 20221012
IS  - 1540-8191 (Electronic)
IS  - 0886-0440 (Linking)
VI  - 36
IP  - 10
DP  - 2021 Oct
TI  - Intraoperative renal hypoxia and risk of cardiac surgery-associated acute kidney 
      injury.
PG  - 3577-3585
LID - 10.1111/jocs.15859 [doi]
AB  - BACKGROUND: Acute kidney injury (AKI) is common after cardiac surgery requiring 
      cardiopulmonary bypass. Renal hypoxia may precede clinically detectable AKI. We 
      compared the efficacy of two indices of renal hypoxia, (i) intraoperative urinary 
      oxygen tension (UPO(2) ) and (ii) the change in plasma erythropoietin (pEPO) 
      during surgery, in predicting AKI. We also investigated whether the performance 
      of these prognostic markers varies with preoperative patient characteristics. 
      METHODS: In 82 patients undergoing on-pump cardiac surgery, blood samples were 
      taken upon induction of anesthesia and upon entry into the intensive care unit. 
      UPO(2) was continuously measured throughout surgery. RESULTS: Thirty-two (39%) 
      patients developed postoperative AKI. pEPO increased during surgery, but this 
      increase did not predict AKI, regardless of risk of postoperative mortality 
      assessed by EuroSCORE-II. For patients categorized at higher risk by 
      EuroSCORE-II >1.98 (median score for the cohort), UPO(2)  </=10 mmHg at any time 
      during surgery predicted a 4.04-fold excess risk of AKI (p = .04). However, 
      UPO(2) did not significantly predict AKI in lower-risk patients. UPO(2) 
      significantly predicted AKI in patients who were older, had previous myocardial 
      infarction, diabetes, lower preoperative serum creatinine, or shorter bypass 
      times. pEPO and UPO(2) were only weakly correlated. CONCLUSIONS: Intraoperative 
      change in pEPO does not predict AKI. However, UPO(2) shows promise, particularly 
      in patients with higher risk of operative mortality. The disparity between these 
      two markers of renal hypoxia may indicate that UPO(2) reflects medullary 
      oxygenation whereas pEPO reflects cortical oxygenation.
CI  - (c) 2021 Wiley Periodicals LLC.
FAU - Ngo, Jennifer P
AU  - Ngo JP
AUID- ORCID: 0000-0001-9980-9640
AD  - Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of 
      Physiology, Monash University, Melbourne, Australia.
AD  - Department of Cardiac Physiology, National Cerebral and Cardiovascular Center 
      Research Institute, Osaka, Japan.
FAU - Noe, Khin M
AU  - Noe KM
AD  - Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of 
      Physiology, Monash University, Melbourne, Australia.
AD  - Department of Surgery, School of Clinical Sciences at Monash Health, Monash 
      University, Melbourne, Australia.
FAU - Zhu, Michael Z L
AU  - Zhu MZL
AUID- ORCID: 0000-0003-4724-008X
AD  - Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of 
      Physiology, Monash University, Melbourne, Australia.
AD  - Department of Cardiothoracic Surgery, Monash Health, Monash University, 
      Melbourne, Australia.
FAU - Martin, Andrew
AU  - Martin A
AD  - Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of 
      Physiology, Monash University, Melbourne, Australia.
AD  - Department of Cardiothoracic Surgery, Monash Health, Monash University, 
      Melbourne, Australia.
FAU - Ollason, Meg
AU  - Ollason M
AD  - Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of 
      Physiology, Monash University, Melbourne, Australia.
FAU - Cochrane, Andrew D
AU  - Cochrane AD
AD  - Department of Surgery, School of Clinical Sciences at Monash Health, Monash 
      University, Melbourne, Australia.
AD  - Department of Cardiothoracic Surgery, Monash Health, Monash University, 
      Melbourne, Australia.
FAU - Smith, Julian A
AU  - Smith JA
AUID- ORCID: 0000-0003-1244-4277
AD  - Department of Surgery, School of Clinical Sciences at Monash Health, Monash 
      University, Melbourne, Australia.
AD  - Department of Cardiothoracic Surgery, Monash Health, Monash University, 
      Melbourne, Australia.
FAU - Thrift, Amanda G
AU  - Thrift AG
AUID- ORCID: 0000-0001-8533-4170
AD  - Department of Medicine, School of Clinical Sciences at Monash Health, Monash 
      University, Melbourne, Australia.
FAU - Evans, Roger G
AU  - Evans RG
AUID- ORCID: 0000-0002-9241-0757
AD  - Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of 
      Physiology, Monash University, Melbourne, Australia.
AD  - Department of Surgery, School of Clinical Sciences at Monash Health, Monash 
      University, Melbourne, Australia.
LA  - eng
GR  - Bridging Postdoctoral Fellowship/Faculty of Medicine, Nursing and Health 
      Sciences, Monash University/
GR  - VG101377/National Heart Foundation of Australia/
GR  - GNT1122455/National Health and Medical Research Council/
PT  - Journal Article
DEP - 20210729
PL  - United States
TA  - J Card Surg
JT  - Journal of cardiac surgery
JID - 8908809
SB  - IM
CIN - J Card Surg. 2022 Aug;37(8):2494. PMID: 35524428
CIN - J Card Surg. 2022 Nov;37(11):4014. PMID: 36047389
MH  - *Acute Kidney Injury/diagnosis/etiology
MH  - *Cardiac Surgical Procedures/adverse effects
MH  - Cardiopulmonary Bypass/adverse effects
MH  - Humans
MH  - Hypoxia/etiology
MH  - Postoperative Complications
MH  - Risk Factors
OTO - NOTNLM
OT  - acute kidney injury
OT  - cardiac surgery
OT  - cardiopulmonary bypass
OT  - erythropoietin
OT  - hypoxia
OT  - urinary oxygen tension
EDAT- 2021/07/31 06:00
MHDA- 2021/09/14 06:00
CRDT- 2021/07/30 07:03
PHST- 2021/07/13 00:00 [revised]
PHST- 2021/05/07 00:00 [received]
PHST- 2021/07/16 00:00 [accepted]
PHST- 2021/07/31 06:00 [pubmed]
PHST- 2021/09/14 06:00 [medline]
PHST- 2021/07/30 07:03 [entrez]
AID - 10.1111/jocs.15859 [doi]
PST - ppublish
SO  - J Card Surg. 2021 Oct;36(10):3577-3585. doi: 10.1111/jocs.15859. Epub 2021 Jul 
      29.