Copyright
©2014 Baishideng Publishing Group Inc.
World J Cardiol. Sep 26, 2014; 6(9): 1006-1021
Published online Sep 26, 2014. doi: 10.4330/wjc.v6.i9.1006
Published online Sep 26, 2014. doi: 10.4330/wjc.v6.i9.1006
Table 1 Definition and classification for acute kidney injury
Serum creatinine/GFR criteria | Urine output criteria | |
RIFLE classification | ||
Definition | SCr rise ≥ 1.5 times baseline or GFR decrease > 25% within 7 d | |
Staging | R (Risk) SCr rise up to 2 times baseline or GFR decrease > 25% | < 0.5 mL/kg per hour for ≥ 6 h |
I (Injury) SCr rise up to 3 times baseline or GFR decrease > 50% | < 0.5 mL/kg per hour for ≥ 12 h | |
F (Failure) SCr rise 3 times baseline or more or GFR decrease > 75% or absolute SCr ≥ 4 mg/dL with acute rise ≥ 0.5 mg/dL | < 0.5 mL/kg per hour for ≥ 24 h or anuria ≥ 12 h | |
L (Loss) persistent AKI > 4 wk, need for RRT | ||
E (ESRD) persistent loss > 3 mo, need for dialysis | ||
AKIN classification | ||
Definition | SCr rise ≥ 1.5 times baseline or ≥ 0.3 mg/dL within 48 h | |
Staging | 1 SCr rise up to 2 times baseline or ≥ 0.3 mg/dL | < 0.5 mL/kg per hour for ≥ 6 h |
2 SCr rise up to 3 times baseline | < 0.5 mL/kg per hour for ≥ 12 h | |
3 SCr rise 3 times baseline or more or absolute SCr ≥ 4 mg/dL with acute rise ≥ 0.5 mg/dL or need for RRT | < 0.3 mL/kg per hour for ≥ 24 h or anuria ≥ 12 h | |
KDIGO classification | ||
Definition | SCr rise ≥ 1.5 times baseline within seven days or ≥ 0.3 mg/dL within 48 h or oliguria | |
Staging | 1 SCr rise up to 2 times baseline or ≥ 0.3 mg/dL | |
2 SCr rise up to 3 times baseline | ||
3 SCr rise 3 times baseline or more or absolute SCr ≥ 4 mg/dL with acute rise ≥ 0.5 mg/dL or need for RRT |
Table 2 Risk factors for acute kidney injury
Preoperative | Intraoperative |
Patient related | Patient related |
Renal dysfunction/high SCr1 | Low venous compliance |
Advanced age | Low systemic vascular resistance |
Female gender | Autoregulatory systems disturbances |
NYHA FC IVReduced LVEF or CHF | Low output syndrome(pressor/IABP need) |
Left main CAD | Type of surgery |
Diabetes mellitus | Valvular |
Poor glycemic control | Re do surgery |
Peripheral vascular disease | Emergency |
COPD | |
Coexisting liver disease | |
Preoperative IABP | |
Pulmonary rales | |
Genetic predisposition | |
Modifiable | Procedure related3 |
Extremes of SBP2 | On-pump cardiac surgery |
Sepsis2 | Nonpulsatile flow on CPB |
Medications (NSAID, ARB) | Hypothermic CPB |
Contrast dye | Deep hypothermic circulatory arrest |
Duration of CPB (> 100-120 min) | |
Perfusion pressure | |
Hemodilution during CPB | |
Blood transfusion | |
Hemolysis | |
Embolism |
Table 3 Potential preventive measures and pharmacological interventions in acute kidney injury
Preventive measures |
Avoidance of nephrotoxic drugs |
Angiotensin-converting enzyme inhibitors |
Angiotensin receptor blockers |
Hydration |
Glycemic control |
Maintenance of renal perfusion |
Goal directed therapy |
Ischemic preconditioning |
Prevention of CI-AKI |
Hydration |
N-acetyl cysteine |
Bicarbonate |
Timing of surgery |
Pharmacological interventions |
Fenoldopam |
Nesiritide |
Sodium bicarbonate |
Mannitol |
Atrial natriuretic peptide |
Brain-type natriuretic peptide |
Early postoperative renal replacement therapy |
Continuous renal replacement therapy |
Ultrafiltration |
- Citation: Najafi M. Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury. World J Cardiol 2014; 6(9): 1006-1021
- URL: https://www.wjgnet.com/1949-8462/full/v6/i9/1006.htm
- DOI: https://dx.doi.org/10.4330/wjc.v6.i9.1006