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Acute kidney injury after cardiac surgery. Impact on long-term outcome and target for intervention

21 January 2009

PhD ceremony: B.G. Loef, 14.45 uur, Academiegebouw, Broerstraat 5, Groningen

Thesis: Acute kidney injury after cardiac surgery. Impact on long-term survival and target for intervention

Promotor(s): prof.dr. T. Ebels, prof.dr. G.J. Navis

Faculty: Medical Sciences

 

Open heart surgery has become a widely performed procedure. This procedure is not without complications. Complications include poor cardiac function, infection, gastrointestinal dysfunction, acute lung injury, stroke, and postoperative acute kidney injury (AKI). Among these complications postoperative AKI is associated with significant morbidity and mortality. Several aspects of postoperative AKI in cardiac surgical patients were evaluated: the influence of cardiopulmonary bypass (CPB) on perioperative renal function; the effects of dexamethasone on perioperative renal dysfunction; the impact of postoperative AKI on long-term survival.

Perioperative renal damage was studied in patients undergoing coronary artery bypass surgery with and without CPB. A transient renal injury was observed in CPB patients, as evidenced by a decrease in tubular function and increased level of biomarkers of glomerular and tubular damage. In the patients operated without CPB these parameters did not change.

The effects of dexamethasone on perioperative renal dysfunction was evaluated in a randomized double-blind study. Perioperative renal function was evaluated by markers for both, glomerular function and damage, and for tubular function and damage. We found that dexamethasone does not exert a protective effect on the transient perioperative renal dysfunction that occurs in cardiac surgical patients undergoing CPB.

In-hospital mortality and long-term survival (follow-up 13.5 yr) was studied for patients with and without postoperative AKI in a cohort of cardiac surgical patients who underwent surgery in 1991. Postoperative AKI in cardiac surgical patients not only increased in-hospital mortality but is also adversely affected long-term survival.

 

Last modified:15 September 2017 3.39 p.m.
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