Intra-abdominal Hypertension and Postoperative Kidney Dysfunction in Cardiac Surgery Patients
Journal of Cardiothoracic and Vascular Anesthesia
acute kidney injury; cardiac surgery; complications; intra-abdominal hypertension; NGAL; postoperative kidney dysfunction
Objective To determine the incidence of intra-abdominal hypertension (IAH) in adult cardiac surgery patients and its association with postoperative kidney dysfunction. Design Prospective cohort study. Setting Single tertiary-care university hospital. Participants Forty-two adult patients having cardiac surgery with cardiopulmonary bypass. Interventions Intra-abdominal pressure (IAP) was measured preoperatively, immediately after surgery, and at the following time points after surgery: 3 hours, 6 hours, 12 hours, and 24 hours. Urine neutrophil gelatinase-associated lipocalin (NGAL) levels were measured as a marker of kidney dysfunction at the following time points: prior to surgery, immediately after surgery, 4 to 6 hours after surgery, and 16-to-18 hours after surgery. Measurements and Main Results Two hundred fifty-two IAPs were measured, and 90 (35.7%) showed IAH. Thirty-five of 42 patients (83.3%) had IAH at 1 time point or more. Peak urine NGAL levels were lower in patients with normal IAP (mean difference = –130.6 ng/mL [95% CI = –211.2 to –50.1], p = 0.002). There was no difference in postoperative kidney dysfunction by risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) criteria in patients with normal IAP (mean difference = –31.4% [95% CI = –48.0 to 6.3], p = 0.09). IAH was 100% sensitive for predicting postoperative kidney dysfunction by RIFLE criteria, but had poor specificity (54.8%). Conclusions IAH occurs frequently during the perioperative period in cardiac surgery patients and may be associated with postoperative kidney dysfunction.
Mazzeffi, M., Stafford, P., Wallace, K., Bernstein, W., Deshpande, S., Odonkor, P., Grewal, A., Strauss, E., Stubbs, L., Gammie, J., & Rock, P. (2016). Intra-abdominal Hypertension and Postoperative Kidney Dysfunction in Cardiac Surgery Patients. Journal of Cardiothoracic and Vascular Anesthesia, 30 (6). http://dx.doi.org/10.1053/j.jvca.2016.05.028