medigraphic.com
ISSN 0326-3428 (Print)
Órgano de difusión científica de la Asociación Nefrológica de Buenos Aires

2021, Number 3

<< Back Next >>

Rev Nefrol Dial Traspl 2021; 41 (3)

Role of ankle brachial index measured by simple automatic sphygmomanometers in predicting postoperative kidney function in patients undergoing major cardiac surgery

Sumnu A, Ozturk S, Cavdar E, Tuba IMF, Cebeci E, Karaali Z, Sahin M

Language: English
References: 27
Page: 192-201
PDF size: 162.88 Kb.


ABSTRACT

Introduction: Ankle-brachial pressure index is an objective, noninvasive test for predicting subclinical atherosclerotic diseases. We investigated the role of anklebrachial pressure index measured with automated sphygmomanometer devices in the prediction of the development of acute kidney injury in patients undergoing major cardiac surgery. Methods: This single-centered, cross-sectional, and observational study was performed on 80 (66 males and 14 females, 58 ± 10 years) patients undergone cardiac surgery. Complete anamnesis, laboratory tests, intravenous fluids, medications, blood products, and all perioperative procedures were recorded in all patients before the surgery. Two automated sphygmomanometer devices giving equivalent results were used for measuring Ankle-brachial pressure index. The data in the first two days after the surgery were used for analysis. The criteria of AKIN were used in the diagnosis of acute kidney injury. Results: Twenty-one (23%) patients developed acute kidney injury in the postoperative period. None of the patients needed renal replacement therapy or died. There was no significant difference between mean ankle-brachial pressure index levels of patients with and without acute kidney injury (1.04 ± 0.17 and 1.06 ± 0.19, respectively, p=0.554). The mean ankle-brachial pressure index was significantly lower in patients with perioperative complications that cause hemodynamic instability (1.07 ± 0.14, 0.96 ± 0.13, p=0.016). On the multivariate analysis model, only perioperative hemodynamic complication development was found to be related to postoperative acute kidney injury. Conclusion: Anklebrachial pressure index may have a role in predicting perioperative hemodynamic complications, which may cause acute kidney injury in patients undergoing major surgery. Simple automatic blood pressure devices can be used in daily practice for ankle-brachial pressure index measurement instead of complex and expensive doppler devices.


REFERENCES

  1. Thakar CV, Arrigain S, Worley S, Yared JP, PaganiniEP. A clinical score to predict acute renal failure aftercardiac surgery. J Am Soc Nephrol. 2005;16(1):162-8.doi: 10.1681/ASN.2004040331.

  2. Wijeysundera DN, Karkouti K, Beattie WS, Rao V,Ivanov J. Improving the identification of patientsat risk of postoperative renal failure after cardiacsurgery. Anesthesiology. 2006;104(1):65-72. doi:10.1097/00000542-200601000-00012.

  3. Haase M, Bellomo R, Story D, Letis A, Klemz K,Matalanis G, et al. Effect of mean arterial pressure,haemoglobin and blood transfusion duringcardiopulmonary bypass on post-operative acute kidneyinjury. Nephrol Dial Transplant. 2012;27(1):153-60.doi: 10.1093/ndt/gfr275.

  4. Thiele RH, Isbell JM, Rosner MH. AKI associated withcardiac surgery. Clin J Am Soc Nephrol. 2015;10(3):500-14. doi: 10.2215/CJN.07830814.

  5. Haase M, Bellomo R, Matalanis G, CalzavaccaP, Dragun D, Haase-Fielitz A. A comparison ofthe RIFLE and Acute Kidney Injury Networkclassifications for cardiac surgery-associated acutekidney injury: a prospective cohort study. J ThoracCardiovasc Surg. 2009;138(6):1370-6. doi: 10.1016/j.jtcvs.2009.07.007.

  6. Coleman MD, Shaefi S, Sladen RN. Preventingacute kidney injury after cardiac surgery. CurrOpin Anaesthesiol. 2011;24(1):70-6. doi: 10.1097/ACO.0b013e3283422ebc.

  7. Coca SG, Garg AX, Thiessen-Philbrook H, KoynerJL, Patel UD, Krumholz HM, et al.; TRIBE-AKIConsortium. Urinary biomarkers of AKI and mortality3 years after cardiac surgery. J Am Soc Nephrol.2014;25(5):1063-71. doi: 10.1681/ASN.2013070742.

  8. Creager MA, White CJ, Hiatt WR, Criqui MH, JosephsSC, Alberts MJ, et al.; American Heart Association.Atherosclerotic Peripheral Vascular Disease SymposiumII: executive summary. Circulation. 2008;118(25):2811-25. doi: 10.1161/CIRCULATIONAHA.108.191170.

  9. Khan NA, Rahim SA, Anand SS, Simel DL, Panju A.Does the clinical examination predict lower extremityperipheral arterial disease? JAMA. 2006;295(5):536-46.doi: 10.1001/jama.295.5.536.

  10. Mourad JJ, Cacoub P, Collet JP, Becker F, Pinel JF,Huet D, et al.; ELLIPSE scientific committee and studyinvestigators. Screening of unrecognized peripheralarterial disease (PAD) using ankle-brachial index inhigh cardiovascular risk patients free from symptomaticPAD. J Vasc Surg. 2009;50(3):572-80. doi: 10.1016/j.jvs.2009.04.055.

  11. Gronewold J, Hermann DM, Lehmann N, KrögerK, Lauterbach K, Berger K, et al.; Heinz NixdorfRecall Study Investigative Group. Ankle-brachial indexpredicts stroke in the general population in addition toclassical risk factors. Atherosclerosis. 2014;233(2):545-50. doi: 10.1016/j.atherosclerosis.2014.01.044.

  12. Matsushita K, Sang Y, Ballew SH, Shlipak M, Katz R,Rosas SE, et al. Subclinical atherosclerosis measures forcardiovascular prediction in CKD. J Am Soc Nephrol.2015;26(2):439-47. doi: 10.1681/ASN.2014020173.

  13. Leng GC, Fowkes FG, Lee AJ, Dunbar J, HousleyE, Ruckley CV. Use of ankle brachial pressure indexto predict cardiovascular events and death: a cohortstudy. BMJ. 1996;313(7070):1440-4. doi: 10.1136/bmj.313.7070.1440.

  14. 2011 Writing Group Members; 2005 WritingCommittee Members; ACCF/AHA Task ForceMembers. 2011 ACCF/AHA Focused Update ofthe Guideline for the Management of patients withperipheral artery disease (Updating the 2005 Guideline):a report of the American College of CardiologyFoundation/American Heart Association Task Force onpractice guidelines. Circulation. 2011;124(18):2020-45. doi: 10.1161/CIR.0b013e31822e80c3.

  15. Davies JH, Williams EM. Automated plethysmographicmeasurement of the ankle-brachial index: a comparisonwith the doppler ultrasound method. Hypertens Res.2016;39(2):100-6. doi: 10.1038/hr.2015.124.

  16. Mehta RL, Kellum JA, Shah SV, Molitoris BA, RoncoC, Warnock DG, et al.; Acute Kidney Injury Network.Acute Kidney Injury Network: report of an initiativeto improve outcomes in acute kidney injury. Crit Care.2007;11(2):R31. doi: 10.1186/cc5713.

  17. Yang J, Lu C, Yan L, Tang X, Li W, Yang Y, Hu D. Theassociation between atherosclerotic renal artery stenosisand acute kidney injury in patients undergoing cardiacsurgery. PLoS One. 2013;8(5):e64104. doi: 10.1371/journal.pone.0064104.

  18. Conlon PJ, Stafford-Smith M, White WD, NewmanMF, King S, Winn MP, et al. Acute renal failurefollowing cardiac surgery. Nephrol Dial Transplant.

  19. 1999;14(5):1158-62. doi: 10.1093/ndt/14.5.1158.19) Mehta RL. Acute renal failure and cardiac surgery:marching in place or moving ahead? J Am Soc Nephrol.

  20. 2005;16(1):12-4. doi: 10.1681/ASN.2004110954.20) Han GF, Zhang JY, Lu S, Li YZ. Etiological andprognostic factors in patients with acute renalfailure after cardiac surgery. Chin J Blood Purific.2005;4(6):302-5.

  21. Wang Y, Bellomo R. Cardiac surgery-associatedacute kidney injury: risk factors, pathophysiology andtreatment. Nat Rev Nephrol. 2017;13(11):697-711.doi: 10.1038/nrneph.2017.119.

  22. Sutton TA, Fisher CJ, Molitoris BA. Microvascularendothelial injury and dysfunction during ischemicacute renal failure. Kidney Int. 2002;62(5):1539-49.doi: 10.1046/j.1523-1755.2002.00631.x.

  23. Cupples WA, Braam B. Assessment of renal autoregulation.Am J Physiol Renal Physiol. 2007;292(4):F1105-23. doi: 10.1152/ajprenal.00194.2006.

  24. Weir MR, Aronson S, Avery EG, Pollack CV Jr.Acute kidney injury following cardiac surgery: role ofperioperative blood pressure control. Am J Nephrol.2011;33(5):438-52. doi: 10.1159/000327601.

  25. Kanji HD, Schulze CJ, Hervas-Malo M, Wang P,Ross DB, Zibdawi M, et al. Difference between preoperativeand cardiopulmonary bypass mean arterialpressure is independently associated with early cardiacsurgery-associated acute kidney injury. J CardiothoracSurg. 2010;5:71. doi: 10.1186/1749-8090-5-71.

  26. Wahba A, Milojevic M, Boer C, De Somer FMJJ,Gudbjartsson T, van den Goor J, et al.; EACTS/EACTA/EBCP Committee Reviewers. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypassin adult cardiac surgery. Eur J Cardiothorac Surg.2020;57(2):210-51. doi: 10.1093/ejcts/ezz267.

  27. Bellomo R, Auriemma S, Fabbri A, D’Onofrio A,Katz N, McCullough PA, et al. The pathophysiologyof cardiac surgery-associated acute kidney injury (CSAAKI).Int J Artif Organs. 2008;31(2):166-78. doi:10.1177/039139880803100210.




2020     |     www.medigraphic.com