de Wijs Calvin J, Streng Lucia W J M, Stolker Robert Jan, Ter Horst Maarten, Hoorn Ewout J, Mahtab Edris A F, Mik Egbert G, Harms Floor A
Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands.
Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands.
J Clin Anesth. 2025 Feb;101:111715. doi: 10.1016/j.jclinane.2024.111715. Epub 2024 Dec 9.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication of cardiac surgery and is associated with increased morbidity and mortality. Recent guidelines emphasize the need for new monitoring methods to facilitate targeted CSA-AKI prevention and treatment strategies. In vivo real-time measurement of mitochondrial oxygen tension (mitoPO), could potentially fulfil this role during cardiac surgery, as suggested in our previous pilot study.
In this prospective observational study, we investigated 75 cardiac surgery patients with an increased preoperative CSA-AKI risk. The primary aim of this study was to assess whether patients who developed CSA-AKI experienced prolonged periods of mitoPO < 20 mmHg during surgery. mitoPO was measured intraoperatively, and CSA-AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Four additional mitoPO thresholds (<25, <30, <35, and < 40 mmHg) were analyzed, including the predictive capacity of all thresholds for CSA-AKI.
This study found that patients who developed CSA-AKI had a significantly longer intraoperative time with mitoPO <20 mmHg and <25, <30, <35, and <40 mmHg. Subsequently, we tested all thresholds for their association with the risk of CSA-AKI, with the <25 mmHg threshold demonstrating the highest significant odds ratio. Every minute spent below <25 mmHg increased the risk of CSA-AKI by 0.7 % (P = 0.021).
This study highlighted the association between mitoPO and the onset of CSA-AKI. Extended durations below the mitoPO threshold of 25 mmHg significantly correlate with an elevated CSA-AKI risk. Using mitoPO as a monitoring tool shows promise in potentially predicting and possibly preventing CSA-AKI when used as a treatment trigger in cardiac surgery patients.
