Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study

Keyvan Karkouti, Hilary P Grocott, Richard I Hall, Michael E Jessen, Cornelis Kruger, Adam B Lerner, Charles MacAdams, C David Mazer, Etirnne de Medicis, Paul S Myles, Fiona Ralley, Michel R Rheault, Antoine Rochon, Mark S Slaughter, Andrew Sternlicht, Summer Syed, Terrence Waters

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Anemia and red blood cell (RBC) transfusion have individually been identified as potentially modifiable risk factors, but their interrelationship with AKI has not been clearly defined. The purpose of this study was to explore the interrelationship of preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery with AKI in cardiac surgery. Methods This historical cohort study included 16 hospitals, each contributing data on approximately 100 consecutive patients who underwent cardiac surgery with cardiopulmonary bypass. Acute kidney injury was defined as a > 50 increase in creatinine levels during the first postoperative week. Multivariable regression was used to identify the interrelationship between preoperative anemia (hemoglobin <130 g?L-1 in males and <120 g?L-1 in females), intraoperative anemia (hemoglobin <80 g?L-1 during cardiopulmonary bypass), RBC transfusion on the day of surgery, and their interaction terms, after adjusting for site and baseline AKI risk. Results Of the 1,444 patients included in the study, 541 (37 ) had preoperative anemia, 501 (35 ) developed intraoperative anemia, 619 (43 ) received RBC transfusions, and 238 (16 ) developed AKI. After risk-adjustment, an individual with the combination of these three risk factors had a 2.6-fold (95 confidence interval 2.0 to 3.3) increase in the relative risk of AKI over an individual with none of these risk factors. Conclusions Preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery are interrelated risk factors for AKI after cardiac surgery. Targeting these risk factors may reduce the burden of AKI.
Original languageEnglish
Pages (from-to)377 - 384
Number of pages8
JournalCanadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Volume62
Issue number4
DOIs
Publication statusPublished - 2015

Cite this

Karkouti, Keyvan ; Grocott, Hilary P ; Hall, Richard I ; Jessen, Michael E ; Kruger, Cornelis ; Lerner, Adam B ; MacAdams, Charles ; Mazer, C David ; de Medicis, Etirnne ; Myles, Paul S ; Ralley, Fiona ; Rheault, Michel R ; Rochon, Antoine ; Slaughter, Mark S ; Sternlicht, Andrew ; Syed, Summer ; Waters, Terrence. / Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study. In: Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie. 2015 ; Vol. 62, No. 4. pp. 377 - 384.
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title = "Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study",
abstract = "Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Anemia and red blood cell (RBC) transfusion have individually been identified as potentially modifiable risk factors, but their interrelationship with AKI has not been clearly defined. The purpose of this study was to explore the interrelationship of preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery with AKI in cardiac surgery. Methods This historical cohort study included 16 hospitals, each contributing data on approximately 100 consecutive patients who underwent cardiac surgery with cardiopulmonary bypass. Acute kidney injury was defined as a > 50 increase in creatinine levels during the first postoperative week. Multivariable regression was used to identify the interrelationship between preoperative anemia (hemoglobin <130 g?L-1 in males and <120 g?L-1 in females), intraoperative anemia (hemoglobin <80 g?L-1 during cardiopulmonary bypass), RBC transfusion on the day of surgery, and their interaction terms, after adjusting for site and baseline AKI risk. Results Of the 1,444 patients included in the study, 541 (37 ) had preoperative anemia, 501 (35 ) developed intraoperative anemia, 619 (43 ) received RBC transfusions, and 238 (16 ) developed AKI. After risk-adjustment, an individual with the combination of these three risk factors had a 2.6-fold (95 confidence interval 2.0 to 3.3) increase in the relative risk of AKI over an individual with none of these risk factors. Conclusions Preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery are interrelated risk factors for AKI after cardiac surgery. Targeting these risk factors may reduce the burden of AKI.",
author = "Keyvan Karkouti and Grocott, {Hilary P} and Hall, {Richard I} and Jessen, {Michael E} and Cornelis Kruger and Lerner, {Adam B} and Charles MacAdams and Mazer, {C David} and {de Medicis}, Etirnne and Myles, {Paul S} and Fiona Ralley and Rheault, {Michel R} and Antoine Rochon and Slaughter, {Mark S} and Andrew Sternlicht and Summer Syed and Terrence Waters",
year = "2015",
doi = "10.1007/s12630-014-0302-y",
language = "English",
volume = "62",
pages = "377 -- 384",
journal = "Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie",
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Karkouti, K, Grocott, HP, Hall, RI, Jessen, ME, Kruger, C, Lerner, AB, MacAdams, C, Mazer, CD, de Medicis, E, Myles, PS, Ralley, F, Rheault, MR, Rochon, A, Slaughter, MS, Sternlicht, A, Syed, S & Waters, T 2015, 'Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study', Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, vol. 62, no. 4, pp. 377 - 384. https://doi.org/10.1007/s12630-014-0302-y

Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study. / Karkouti, Keyvan; Grocott, Hilary P; Hall, Richard I; Jessen, Michael E; Kruger, Cornelis; Lerner, Adam B; MacAdams, Charles; Mazer, C David; de Medicis, Etirnne; Myles, Paul S; Ralley, Fiona; Rheault, Michel R; Rochon, Antoine; Slaughter, Mark S; Sternlicht, Andrew; Syed, Summer; Waters, Terrence.

In: Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, Vol. 62, No. 4, 2015, p. 377 - 384.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study

AU - Karkouti, Keyvan

AU - Grocott, Hilary P

AU - Hall, Richard I

AU - Jessen, Michael E

AU - Kruger, Cornelis

AU - Lerner, Adam B

AU - MacAdams, Charles

AU - Mazer, C David

AU - de Medicis, Etirnne

AU - Myles, Paul S

AU - Ralley, Fiona

AU - Rheault, Michel R

AU - Rochon, Antoine

AU - Slaughter, Mark S

AU - Sternlicht, Andrew

AU - Syed, Summer

AU - Waters, Terrence

PY - 2015

Y1 - 2015

N2 - Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Anemia and red blood cell (RBC) transfusion have individually been identified as potentially modifiable risk factors, but their interrelationship with AKI has not been clearly defined. The purpose of this study was to explore the interrelationship of preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery with AKI in cardiac surgery. Methods This historical cohort study included 16 hospitals, each contributing data on approximately 100 consecutive patients who underwent cardiac surgery with cardiopulmonary bypass. Acute kidney injury was defined as a > 50 increase in creatinine levels during the first postoperative week. Multivariable regression was used to identify the interrelationship between preoperative anemia (hemoglobin <130 g?L-1 in males and <120 g?L-1 in females), intraoperative anemia (hemoglobin <80 g?L-1 during cardiopulmonary bypass), RBC transfusion on the day of surgery, and their interaction terms, after adjusting for site and baseline AKI risk. Results Of the 1,444 patients included in the study, 541 (37 ) had preoperative anemia, 501 (35 ) developed intraoperative anemia, 619 (43 ) received RBC transfusions, and 238 (16 ) developed AKI. After risk-adjustment, an individual with the combination of these three risk factors had a 2.6-fold (95 confidence interval 2.0 to 3.3) increase in the relative risk of AKI over an individual with none of these risk factors. Conclusions Preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery are interrelated risk factors for AKI after cardiac surgery. Targeting these risk factors may reduce the burden of AKI.

AB - Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Anemia and red blood cell (RBC) transfusion have individually been identified as potentially modifiable risk factors, but their interrelationship with AKI has not been clearly defined. The purpose of this study was to explore the interrelationship of preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery with AKI in cardiac surgery. Methods This historical cohort study included 16 hospitals, each contributing data on approximately 100 consecutive patients who underwent cardiac surgery with cardiopulmonary bypass. Acute kidney injury was defined as a > 50 increase in creatinine levels during the first postoperative week. Multivariable regression was used to identify the interrelationship between preoperative anemia (hemoglobin <130 g?L-1 in males and <120 g?L-1 in females), intraoperative anemia (hemoglobin <80 g?L-1 during cardiopulmonary bypass), RBC transfusion on the day of surgery, and their interaction terms, after adjusting for site and baseline AKI risk. Results Of the 1,444 patients included in the study, 541 (37 ) had preoperative anemia, 501 (35 ) developed intraoperative anemia, 619 (43 ) received RBC transfusions, and 238 (16 ) developed AKI. After risk-adjustment, an individual with the combination of these three risk factors had a 2.6-fold (95 confidence interval 2.0 to 3.3) increase in the relative risk of AKI over an individual with none of these risk factors. Conclusions Preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery are interrelated risk factors for AKI after cardiac surgery. Targeting these risk factors may reduce the burden of AKI.

UR - http://link.springer.com/article/10.1007%2Fs12630-014-0302-y

U2 - 10.1007/s12630-014-0302-y

DO - 10.1007/s12630-014-0302-y

M3 - Article

VL - 62

SP - 377

EP - 384

JO - Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie

JF - Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie

SN - 0832-610X

IS - 4

ER -