Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury.
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2021-05
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Abstract
Objective
Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) serves to hemoconcentrate blood volume to avoid allogeneic blood transfusions. Previous studies have determined CUF volumes as a continuous variable are associated with postoperative acute kidney injury (AKI) after cardiac surgery, but optimal weight-indexed volumes that predict AKI have not been described.Design
Retrospective cohort.Setting
Single-center university hospital.Participants
A total of 1,641 consecutive patients who underwent elective cardiac surgery between June 2013 and December 2015.Interventions
The CUF volume was removed during CPB in all participants as part of routine practice. The authors investigated the association of dichotomized weight-indexed CUF volume removal with postoperative AKI development to provide pragmatic guidance for clinical practice at the authors' institution.Measurements and main results
Primary outcomes of postoperative AKI were defined by the Kidney Disease: Improving Global Outcomes staging criteria and dichotomized, weight-indexed CUF volumes (mL/kg) were defined by (1) extreme quartiles (Q3) and (2) Youden's criterion that best predicted AKI development. Multivariate logistic regression models were developed to test the association of these dichotomized indices with AKI status. Postoperative AKI occurred in 827 patients (50.4%). Higher CUF volumes were associated with AKI development by quartiles (CUF >Q3 = 32.6 v CUF < Q1 = 10.4 mL/kg; odds ratio [OR] = 1.68, 95% CI: 1.19-2.3) and Youden's criterion (CUF ≥ 32.9 v CUF <32.9 mL/kg; OR = 1.60, 95% CI: 1.21-2.13). Despite similar intraoperative nadir hematocrits among groups (p = 0.8), higher CUF volumes were associated with more allogeneic blood transfusions (p = 0.002) and longer lengths of stay (p < 0.001).Conclusions
Removal of weight-indexed CUF volumes > 32 mL/kg increased the risk for postoperative AKI development. Importantly, CUF volume removal of any amount did not mitigate allogeneic blood transfusion during elective cardiac surgery. Prospective studies are needed to validate these findings.Type
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Manning, Michael W, Yi-Ju Li, Dean Linder, John C Haney, Yi-Hung Wu, Mihai V Podgoreanu, Madhav Swaminathan, Jacob N Schroder, et al. (2021). Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury. Journal of cardiothoracic and vascular anesthesia, 35(5). pp. 1310–1318. 10.1053/j.jvca.2020.11.036 Retrieved from https://hdl.handle.net/10161/29718.
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Michael Wayne Manning
Dr. Michael W. Manning, MD, Ph.D., is an Associate Professor at Duke University Medical Center, within the Divisions of Cardiothoracic and General, Vascular, and Transplant anesthesia. He serves as the director of Enhanced Recovery after Surgery programs and the director of research for the Perioperative Medicine Fellowship at Duke. His clinical practice focuses on high-risk cardiac surgery, Heart, Lung, and Liver transplantation.
Dr. Manning earned a Ph.D. in cardiovascular physiology from the University of Kentucky, where he studied the role of Angiotensin II-mediated inflammation in the development of abdominal aortic aneurysms. After graduate school, Dr. Manning remained at the University of Kentucky, earning his MD degree. He completed a year of general surgery residency before switching to anesthesia. Following residency, Dr.
Manning continued his clinical training at Duke University with a one-year clinical fellowship in Adult Cardiothoracic Anesthesiology and a 2-year research fellowship. He joined the Duke faculty in 2014.
His current research interests are ERAS centered, specifically in the role of opioid-free anesthesia and goal-directed fluid therapy in cardiac surgery on renal outcomes.
Yi-Ju Li
My research interest is in statistical genetics, including statistical method development and its application for understanding the genetic predisposition of human complex diseases. Here is the list of research topics:
- Statistical genetics: development of family-based association methods for quantitative traits with or without censoring and for detecting X-linked genes for disease risk. With the availability of next generation sequencing data, we have ongoing projects to develop the association methods for testing rare variants for different phenotypic measures.
- Genetics of Alzheimer's disease (AD) and Fuchs endothelial corneal dystrophy (FECD).
- Genetic basis of age-at-onset of Alzheimer disease.
- Peri-operative genomic studies. Investigate the genetic risk factors for postoperative outcomes of patients underwent non-emergent coronary artery bypass grafting with cardiopulmonary bypass.
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