Risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Jing ¹ ,  JIANG Yunlan ² , ZHANG Yue ¹ , LIU Yaxin ¹ , HUANG Xiaoxing ¹ , SHEN Yinli ²

1. School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P. R. China;
2. Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P. R. China;

Corresponding?author：

JIANG Yunlan, Email: 18980880152@163.com

Keywords：

Off-pump coronary artery bypass grafting; acute kidney injury; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202205061

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Objective To analyze the risk factors for acute kidney injury (AKI) after off-pump coronary artery bypass grafting (OPCABG). Methods The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang data, CBM, VIP, CNKI were searched by computer for researches on risk factors associated with the development of AKI after OPCABG from the inception to March 2022. The meta-analysis was performed using RevMan 5.4 software. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies.Results A total of 18 researches were included, involving 9 risk factors. The NOS score of all included studies was≥6 points. Meta-analysis results showed that age [OR=1.03, 95%CI (1.01, 1.06), P=0.020], body mass index (BMI) [OR=1.10, 95%CI (1.05, 1.15), P<0.001], history of hypertension [OR=1.45, 95%CI (1.27, 1.66), P<0.001], history of diabetes [OR=1.50, 95%CI (1.33, 1.70), P<0.001], preoperative serum creatinine level [OR=2.05, 95%CI (1.27, 3.32), P=0.003], low left ventricular ejection fraction [OR=4.51, 95%CI (1.39, 14.65), P=0.010], preoperative coronary angiography within a short period of time [OR=2.10, 95%CI (1.52, 2.91), P<0.001], perioperative implantation of intra-aortic balloon pump [OR=3.42, 95%CI (2.26, 5.16), P<0.001], perioperative blood transfusion [OR=2.00, 95%CI (1.51, 2.65), P<0.001] were risk factors for AKI after OPCABG. Conclusion Age, BMI, history of hypertension, history of diabetes, preoperative serum creatinine level, low left ventricular ejection fraction, preoperative coronary angiography within a short period of time, perioperative implantation of intra-aortic balloon pump, perioperative blood transfusion are risk factors for AKI after OPCABG. Medical staff should focus on monitoring the above risk factors and early identifying, in order to prevent or delay the onset of postoperative AKI and promote early recovery of patients.

Citation： PAN Jing, JIANG Yunlan, ZHANG Yue, LIU Yaxin, HUANG Xiaoxing, SHEN Yinli. Risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 1048-1054. doi: 10.7507/1007-4848.202205061 Copy

1.	Park J, Lee JH, Kim KA, et al. Effects of preoperative statin on acute kidney injury after off-pump coronary artery bypass grafting. J Am Heart Assoc, 2019, 8(7): e010892.
2.	王睿, 朱一帆, 陳文, 等. 體外與非體外循環冠狀動脈旁路移植術后急性腎損傷對比. 中華胸心血管外科雜志, 2019, 35(3): 167-170.
3.	Palazuelos J, Clares Montón P, Rubio Alonso M. Acute kidney injury after cardiac surgery is not always related to coronary angiography timing. J Thorac Cardiovasc Surg, 2016, 152(1): 262-263.
4.	Hong S, Youn YN, Yoo KJ. Metabolic syndrome as a risk factor for postoperative kidney injury after off-pump coronary artery bypass surgery. Circ J, 2010, 74(6): 1121-1126.
5.	Lamy A, Devereaux PJ, Prabhakaran D, et al. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med, 2013, 368(13): 1179-1188.
6.	Wang R, Wang X, Zhu Y, et al. Acute kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: A retrospective propensity score matching analysis. J Cardiothorac Surg, 2020, 15(1): 186.
7.	吳硯銘, 王彥, 李佳龍, 等. 二甲雙胍與糖尿病患者食管癌發生風險及預后相關性的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2022, 29(2): 179-185.
8.	賀源, 徐紅黨, 林洪啟, 等. 非體外循環冠狀動脈旁路移植術后急性腎損傷的危險因素. 中華麻醉學雜志, 2021, 41(9): 1079-1082.
9.	董高翔, 嚴中亞. 不停跳冠脈搭橋術后急性腎損傷的危險因素分析. 安徽衛生職業技術學院學報, 2019, 18(2): 25-26, 29.
10.	吳婷婷, 王紅, 邵涓涓, 等. 尿酸對非體外循環冠狀動脈旁路移植術后急性腎損傷的影響. 中華胸心血管外科雜志, 2019, 35(5): 294-298.
11.	Liu W, Xi Z, Gu C, et al. Impact of major bleeding on the risk of acute kidney injury in patients undergoing off-pump coronary artery bypass grafting. J Thorac Dis, 2018, 10(6): 3381-3389.
12.	李西慧, 肖鋒, 張思宇. 不停跳冠狀動脈旁路移植術后急性腎損傷的影響因素探討及3年隨訪結果. 北京大學學報(醫學版), 2017, 49(1): 131-136.
13.	張智彪, 奚吉成, 王崇軍, 等. 術前白蛋白與非體外循環下冠狀動脈搭橋患者術后急性腎功能損傷的相關性分析. 中國臨床實用醫學, 2017, 8(6): 46-48.
14.	Kumada Y, Yoshitani K, Shimabara Y, et al. Perioperative risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A retrospective study. JA Clin Rep, 2017, 3(1): 55.
15.	韓增強, 陳生龍, 劉剛, 等. 非體外冠狀動脈旁路移植術后急性腎損傷臨床分析. 臨床心血管病雜志, 2016, 32(8): 819-822.
16.	張仁騰, 王輝山, 姜輝, 等. 非體外循環冠狀動脈旁路移植術后腎損傷風險因素的分析. 心肺血管病雜志, 2016, 35(4): 285-289.
17.	艾力夏提·阿里甫, 張明明, 木拉提·阿不都熱合曼, 等. 非體外循環下冠狀動脈旁路移植術后急性腎損傷的相關因素分析. 中國微創外科雜志, 2016, 16(3): 197-200.
18.	郭建中, 李大連, 程智廣, 等. 非體外循環下冠狀動脈旁路移植術后急性腎損傷危險因素分析. 國際外科學雜志, 2014, 41(11): 747-750.
19.	Song JW, Shim JK, Yoo KJ, et al. Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass. Interact Cardiovasc Thorac Surg, 2013, 17(3): 473-478.
20.	桂雷, 陳慶良, 姜楠, 等. 非體外循環冠狀動脈旁路移植術后急性腎損傷的危險因素分析. 天津醫藥, 2012, 40(4): 387-388.
21.	Lee EH, Baek SH, Chin JH, et al. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med, 2012, 38(9): 1478-1486.
22.	Ji Q, Mei Y, Wang X, et al. Effect of elapsed time from coronary angiography until off-pump coronary artery bypass surgery on postoperative renal function. Circ J, 2012, 76(10): 2356-2362.
23.	Kim MY, Jang HR, Huh W, et al. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Ren Fail, 2011, 33(3): 316-322.
24.	Zhang Y, Ye N, Chen YP, et al. Relation between the interval from coronary angiography to selective off-pump coronary artery bypass grafting and postoperative acute kidney injury. Am J Cardiol, 2013, 112(10): 1571-1575.
25.	Hall JE, do Carmo JM, da Silva AA, et al. Obesity, kidney dysfunction and hypertension: Mechanistic links. Nat Rev Nephrol, 2019, 15(6): 367-385.
26.	Shi N, Liu K, Fan Y, et al. The association between obesity and risk of acute kidney injury after cardiac surgery. Front Endocrinol (Lausanne), 2020, 11: 534294.
27.	Yu SM, Bonventre JV. Acute kidney injury and progression of diabetic kidney disease. Adv Chronic Kidney Dis, 2018, 25(2): 166-180.
28.	Hertzberg D, Sartipy U, Holzmann MJ. Type 1 and type 2 diabetes mellitus and risk of acute kidney injury after coronary artery bypass grafting. Am Heart J, 2015, 170(5): 895-902.
29.	Schopka S, Diez C, Camboni D, et al. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: A matched pair analysis. J Cardiothorac Surg, 2014, 9: 20.
30.	唐巧, 李怡, 李貴森, 等. 急性腎損傷有關生物標志物的研究進展. 實用醫院臨床雜志, 2022, 19(2): 225-228.
31.	Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: Risk factors, pathophysiology and treatment. Nat Rev Nephrol, 2017, 13(11): 697-711.
32.	Lee EH, Chin JH, Joung KW, et al. Impact of the time of coronary angiography on acute kidney injury after elective off-pump coronary artery bypass surgery. Ann Thorac Surg, 2013, 96(5): 1635-1641.
33.	牛永勝, 章淬, 薛寅瑩, 等. 冠狀動脈旁路移植術后急性腎損傷的危險因素臨床分析. 國際外科學雜志, 2014, 41(12): 820-823.
34.	張萬程, 孫俊杰, 魯顯慧, 等. 高危老年患者行冠狀動脈搭橋術后急性腎損傷的危險因素分析. 臨床心血管病雜志, 2019, 35(1): 65-69.

1. Park J, Lee JH, Kim KA, et al. Effects of preoperative statin on acute kidney injury after off-pump coronary artery bypass grafting. J Am Heart Assoc, 2019, 8(7): e010892.
2. 王睿, 朱一帆, 陳文, 等. 體外與非體外循環冠狀動脈旁路移植術后急性腎損傷對比. 中華胸心血管外科雜志, 2019, 35(3): 167-170.
3. Palazuelos J, Clares Montón P, Rubio Alonso M. Acute kidney injury after cardiac surgery is not always related to coronary angiography timing. J Thorac Cardiovasc Surg, 2016, 152(1): 262-263.
4. Hong S, Youn YN, Yoo KJ. Metabolic syndrome as a risk factor for postoperative kidney injury after off-pump coronary artery bypass surgery. Circ J, 2010, 74(6): 1121-1126.
5. Lamy A, Devereaux PJ, Prabhakaran D, et al. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med, 2013, 368(13): 1179-1188.
6. Wang R, Wang X, Zhu Y, et al. Acute kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: A retrospective propensity score matching analysis. J Cardiothorac Surg, 2020, 15(1): 186.
7. 吳硯銘, 王彥, 李佳龍, 等. 二甲雙胍與糖尿病患者食管癌發生風險及預后相關性的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2022, 29(2): 179-185.
8. 賀源, 徐紅黨, 林洪啟, 等. 非體外循環冠狀動脈旁路移植術后急性腎損傷的危險因素. 中華麻醉學雜志, 2021, 41(9): 1079-1082.
9. 董高翔, 嚴中亞. 不停跳冠脈搭橋術后急性腎損傷的危險因素分析. 安徽衛生職業技術學院學報, 2019, 18(2): 25-26, 29.
10. 吳婷婷, 王紅, 邵涓涓, 等. 尿酸對非體外循環冠狀動脈旁路移植術后急性腎損傷的影響. 中華胸心血管外科雜志, 2019, 35(5): 294-298.
11. Liu W, Xi Z, Gu C, et al. Impact of major bleeding on the risk of acute kidney injury in patients undergoing off-pump coronary artery bypass grafting. J Thorac Dis, 2018, 10(6): 3381-3389.
12. 李西慧, 肖鋒, 張思宇. 不停跳冠狀動脈旁路移植術后急性腎損傷的影響因素探討及3年隨訪結果. 北京大學學報(醫學版), 2017, 49(1): 131-136.
13. 張智彪, 奚吉成, 王崇軍, 等. 術前白蛋白與非體外循環下冠狀動脈搭橋患者術后急性腎功能損傷的相關性分析. 中國臨床實用醫學, 2017, 8(6): 46-48.
14. Kumada Y, Yoshitani K, Shimabara Y, et al. Perioperative risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A retrospective study. JA Clin Rep, 2017, 3(1): 55.
15. 韓增強, 陳生龍, 劉剛, 等. 非體外冠狀動脈旁路移植術后急性腎損傷臨床分析. 臨床心血管病雜志, 2016, 32(8): 819-822.
16. 張仁騰, 王輝山, 姜輝, 等. 非體外循環冠狀動脈旁路移植術后腎損傷風險因素的分析. 心肺血管病雜志, 2016, 35(4): 285-289.
17. 艾力夏提·阿里甫, 張明明, 木拉提·阿不都熱合曼, 等. 非體外循環下冠狀動脈旁路移植術后急性腎損傷的相關因素分析. 中國微創外科雜志, 2016, 16(3): 197-200.
18. 郭建中, 李大連, 程智廣, 等. 非體外循環下冠狀動脈旁路移植術后急性腎損傷危險因素分析. 國際外科學雜志, 2014, 41(11): 747-750.
19. Song JW, Shim JK, Yoo KJ, et al. Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass. Interact Cardiovasc Thorac Surg, 2013, 17(3): 473-478.
20. 桂雷, 陳慶良, 姜楠, 等. 非體外循環冠狀動脈旁路移植術后急性腎損傷的危險因素分析. 天津醫藥, 2012, 40(4): 387-388.
21. Lee EH, Baek SH, Chin JH, et al. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med, 2012, 38(9): 1478-1486.
22. Ji Q, Mei Y, Wang X, et al. Effect of elapsed time from coronary angiography until off-pump coronary artery bypass surgery on postoperative renal function. Circ J, 2012, 76(10): 2356-2362.
23. Kim MY, Jang HR, Huh W, et al. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Ren Fail, 2011, 33(3): 316-322.
24. Zhang Y, Ye N, Chen YP, et al. Relation between the interval from coronary angiography to selective off-pump coronary artery bypass grafting and postoperative acute kidney injury. Am J Cardiol, 2013, 112(10): 1571-1575.
25. Hall JE, do Carmo JM, da Silva AA, et al. Obesity, kidney dysfunction and hypertension: Mechanistic links. Nat Rev Nephrol, 2019, 15(6): 367-385.
26. Shi N, Liu K, Fan Y, et al. The association between obesity and risk of acute kidney injury after cardiac surgery. Front Endocrinol (Lausanne), 2020, 11: 534294.
27. Yu SM, Bonventre JV. Acute kidney injury and progression of diabetic kidney disease. Adv Chronic Kidney Dis, 2018, 25(2): 166-180.
28. Hertzberg D, Sartipy U, Holzmann MJ. Type 1 and type 2 diabetes mellitus and risk of acute kidney injury after coronary artery bypass grafting. Am Heart J, 2015, 170(5): 895-902.
29. Schopka S, Diez C, Camboni D, et al. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: A matched pair analysis. J Cardiothorac Surg, 2014, 9: 20.
30. 唐巧, 李怡, 李貴森, 等. 急性腎損傷有關生物標志物的研究進展. 實用醫院臨床雜志, 2022, 19(2): 225-228.
31. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: Risk factors, pathophysiology and treatment. Nat Rev Nephrol, 2017, 13(11): 697-711.
32. Lee EH, Chin JH, Joung KW, et al. Impact of the time of coronary angiography on acute kidney injury after elective off-pump coronary artery bypass surgery. Ann Thorac Surg, 2013, 96(5): 1635-1641.
33. 牛永勝, 章淬, 薛寅瑩, 等. 冠狀動脈旁路移植術后急性腎損傷的危險因素臨床分析. 國際外科學雜志, 2014, 41(12): 820-823.
34. 張萬程, 孫俊杰, 魯顯慧, 等. 高危老年患者行冠狀動脈搭橋術后急性腎損傷的危險因素分析. 臨床心血管病雜志, 2019, 35(1): 65-69.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A systematic review and meta-analysis

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