Singh Waryaam, Yalamuri Suraj, Nikravangolsefid Nasrin, Suppadungsuk Supawadee, Goyal Shriya, Hanson Andrew, Kashani Kianoush
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.
Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Rochester, MN.
J Cardiothorac Vasc Anesth. 2025 Jan;39(1):104-111. doi: 10.1053/j.jvca.2024.10.018. Epub 2024 Oct 11.
To explore whether ultrafiltration (UF) volume adjusted for weight is associated with an increased risk of acute kidney injury (AKI) after cardiopulmonary bypass (CPB) in cardiac surgery patients.
A retrospective cohort study.
Single-center study at a tertiary academic medical center.
A total of 2369 adult patients (age ≥18 years) who underwent cardiac surgery with CPB between January 2018 and August 2019.
The cohort was divided into 4 groups based on weight-adjusted conventional UF volume: 0 (no UF), 0.1 to 17.9 mL, 18 to 29.9 mL, and >30 mL ultrafiltration for each kg of body weight. Demographic data, laboratory findings, comorbidities, medications, and surgical details were collected. Postoperative AKI was defined by the KDIGO (Kidney Disease: Improving Global Outcomes) staging criteria and assessed in all UF groups. The association between UF volume and AKI according to nadir hemoglobin (Hb) level and red blood cell transfusion volume was explored.
Postoperative AKI occurred in 840 patients (35.4%). The incidence of AKI post-CPB in patients was similar in patients with 0 mL/kg (34.4%; n = 123), 0.1 to 17.9 mL/kg (34.3%; n = 387), and 18 to 29.9 mL/kg (33.7%; n = 173) of UF volume. The patients with UF volume >30 mL/kg had a higher incidence of AKI (42.7%; n = 157; p = 0.019). For each additional 10 mL/kg increase in UF, the odds ratio (OR) of AKI was 1.14 (95% confidence interval [CI], 1.07-1.20; p < 0.001) following adjustments for preoperative covariates. However, the association was mitigated following adjustments for preoperative and intraoperative covariates (OR, 1.07; 95% CI, 0.99-1.16; p = 0.076). Although higher UF also was associated with an increased risk of AKI in patients with nadir Hb levels of 6 to 8 g/dL (adjusted OR, 1.24 and 1.22; p = 0.02), it was not significantly associated with AKI when nadir Hb was 10 to 12 g/dL. Red blood cell transfusion volume was not related to changes in AKI incidence.
This study suggests that conventional UF is a potential risk factor for AKI incidence following surgery with CPB. The results demonstrate an association between higher weight-adjusted ultrafiltration volume and a higher incidence of AKI. Future studies should incorporate a multicenter, prospective approach to test the generalizability of the present findings and validate modified ultrafiltration strategies that use hemodynamic variables to determine fluid removal volume.
探讨心脏手术患者体外循环（CPB）后按体重调整的超滤（UF）量是否与急性肾损伤（AKI）风险增加相关。
一项回顾性队列研究。
一家三级学术医疗中心的单中心研究。
2018年1月至2019年8月期间接受CPB心脏手术的2369例成年患者（年龄≥18岁）。
根据体重调整的传统超滤量将队列分为4组：0（无超滤）、0.1至17.9 mL、18至29.9 mL以及每千克体重超滤量>30 mL。收集人口统计学数据、实验室检查结果、合并症、用药情况及手术细节。术后AKI根据KDIGO（改善全球肾脏病预后组织）分期标准定义，并在所有超滤组中进行评估。探讨了根据最低血红蛋白（Hb）水平和红细胞输注量，超滤量与AKI之间的关联。
840例患者（35.4%）发生术后AKI。超滤量为0 mL/kg（34.4%；n = 123）、0.1至17.9 mL/kg（34.3%；n = 387）和18至29.9 mL/kg（33.7%；n = 173）的患者CPB后AKI发生率相似。超滤量>30 mL/kg的患者AKI发生率较高（42.7%；n = 157；p = 0.019）。在对术前协变量进行调整后，超滤量每增加10 mL/kg，AKI的比值比（OR）为1.14（95%置信区间[CI]，1.07 - 1.20；p < 0.001）。然而，在对术前和术中协变量进行调整后，这种关联减弱（OR，1.07；95% CI，0.99 - 1.16；p = 0.076）。尽管较高的超滤量在最低Hb水平为6至8 g/dL的患者中也与AKI风险增加相关（调整后OR，1.24和1.22；p = 0.02），但当最低Hb为10至12 g/dL时，与AKI无显著关联。红细胞输注量与AKI发生率的变化无关。
本研究表明传统超滤是CPB手术后AKI发生的潜在危险因素。结果显示较高的体重调整超滤量与较高的AKI发生率之间存在关联。未来的研究应采用多中心、前瞻性方法来检验本研究结果的普遍性，并验证使用血流动力学变量来确定液体清除量的改良超滤策略。
