Intraoperative renal hypoxia and risk of cardiac surgery-associated acute kidney injury.
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 (UPO2 ) 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. UPO2 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), UPO2  ≤10 mmHg at any time during surgery predicted a 4.04-fold excess risk of AKI (p = .04). However, UPO2 did not significantly predict AKI in lower-risk patients. UPO2 significantly predicted AKI in patients who were older, had previous myocardial infarction, diabetes, lower preoperative serum creatinine, or shorter bypass times. pEPO and UPO2 were only weakly correlated.


CONCLUSIONS
Intraoperative change in pEPO does not predict AKI. However, UPO2 shows promise, particularly in patients with higher risk of operative mortality. The disparity between these two markers of renal hypoxia may indicate that UPO2 reflects medullary oxygenation whereas pEPO reflects cortical oxygenation.
['Ngo|Jennifer P|JP|http://orcid.org/0000-0001-9980-9640', 'Noe|Khin M|KM|', 'Zhu|Michael Z L|MZL|https://orcid.org/0000-0003-4724-008X', 'Martin|Andrew|A|', 'Ollason|Meg|M|', 'Cochrane|Andrew D|AD|', 'Smith|Julian A|JA|https://orcid.org/0000-0003-1244-4277', 'Thrift|Amanda G|AG|https://orcid.org/0000-0001-8533-4170', 'Evans|Roger G|RG|https://orcid.org/0000-0002-9241-0757']
D058186:Acute Kidney Injury D006348:Cardiac Surgical Procedures D002315:Cardiopulmonary Bypass D006801:Humans D000860:Hypoxia D011183:Postoperative Complications D012307:Risk Factors
hypoxia acute kidney injury cardiac surgery cardiopulmonary bypass urinary oxygen tension erythropoietin