Risk of Acute Kidney Injury With Same Admission Cardiac Catheterization and Cardiac Surgery

Acute kidney injury (AKI) after open cardiac operations is associated with increased morbidity and short-term and long-term mortality. Prevention of AKI during and after surgery is of paramount importance. The Acute Kidney Injury Network definition of AKI is a 0.3 mg/dL or 50% increase in baseline creatinine value. It is common practice to provide diagnostic cardiac catheterization and cardiac surgery in the same admission. This practice may lead to a higher risk of AKI with attendant increased risks for a higher morbidity and mortality. The question, therefore, remains as to the optimal timing of cardiac surgery following cardiac catheterization. A recent prospective study from the Northern New England Cardiovascular Disease Study Group looked at the incidence of AKI after cardiac catheterization in 668 patients undergoing nonemergent cardiac surgery during the same hospital admission (367 patients) or a later admission (301 patients) (Kramer et al. Ann Thorac Surg. 2010; 90[5]:1418).

The incidence of AKI was 50.2% in the same admission group vs 33.7% for the later admission group. The difference was highly significant (P=.009). Patients undergoing surgery at a later admission had a 45% reduction in AKI. The authors concluded that “it is safe and possibly beneficial in terms of renal protection, to send patients home after cardiac catheterization with a plan for surgery during subsequent admission.”

Dr G. Hossein Almassi, FCCP
NetWork Vice-Chair