Shrunken pore syndrome increased the risk of acute kidney injury after cardiac surgery: a cohort study.
Patients with shrunken pore syndrome have a significantly higher risk of acute kidney injury after coronary artery bypass grafting, indicating the need for careful monitoring.
Where it sits
this study against the rest of the epitalon (epithalon) corpusSummary and findings
This study measured the incidence of acute kidney injury (AKI) in patients with shrunken pore syndrome (SPS) after isolated coronary artery bypass grafting (CABG). A total of 1277 patients were included, with 164 diagnosed with SPS before surgery. The incidence of AKI was significantly higher in the SPS group compared to the non-SPS group.
Abstract
<h4>Background</h4>Shrunken pore syndrome (SPS), as a selective glomerular hypofiltration syndrome, has received increasing attention. Therefore, we hypothesised that patients with SPS have a high risk of postoperative acute kidney injury (AKI).<h4>Methods</h4>This trial was a retrospective cohort study. Patients who received isolated coronary artery bypass grafting (CABG) in the Affiliated Hospital of Qingdao University were continuously reviewed. Estimated glomerular filtration rates (eGFRs) were calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. The SPS was defined as an eGFR based on cystatin C < 70% of the eGFR based on creatinine. Postoperative AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and the occurrence of AKI within seven days after surgery was followed up.<h4>Results</h4>A total of 1277 patients were included, and the incidence of postoperative AKI was 23.2% (296/1277), and 12.8% (164/1277) patients were diagnosed with SPS before surgery. The incidence of AKI in the SPS group was significantly higher than that in the non-SPS group (33.5% vs. 21.7%, adjOR = 1.613, 95%CI 1.121-2.322, <i>p</i> = 0.010). Sensitivity analysis: <i>E</i>-value = 2.175 and Fragility Index = 8. The results remained robust across all subgroups. After propensity score matching, the incidence of AKI in SPS group was still significantly higher than that in the non-SPS group (33.5% vs. 22.9%, adjOR = 1.702, 95%CI 1.131-2.560, <i>p</i> = 0.011).<h4>Conclusions</h4>SPS is an independent risk factor for AKI after CABG. It will bring a new insight for an accurate clinical assessment of the risk of postoperative AKI.
Background
This paper addresses the relationship between shrunken pore syndrome (SPS) and the risk of acute kidney injury (AKI) following cardiac surgery. Prior studies have suggested that SPS may influence glomerular filtration rates, but the specific risk of postoperative AKI has not been thoroughly investigated. Understanding this relationship is crucial for improving patient outcomes after coronary artery bypass grafting (CABG).
Methods
This was a retrospective cohort study involving patients who underwent isolated CABG at the Affiliated Hospital of Qingdao University. The study included 1277 patients, with SPS defined as an estimated glomerular filtration rate (eGFR) based on cystatin C < 70% of the eGFR based on creatinine. Postoperative AKI was diagnosed using KDIGO criteria, with follow-up for AKI occurrence within seven days after surgery.
Results
The primary endpoint indicated that the incidence of postoperative AKI was 23.2% (296/1277). In patients diagnosed with SPS, the incidence of AKI was significantly higher at 33.5% compared to 21.7% in the non-SPS group (adjOR = 1.613, 95%CI 1.121-2.322, p = 0.010). After propensity score matching, the incidence remained significantly higher in the SPS group at 33.5% vs. 22.9% (adjOR = 1.702, 95%CI 1.131-2.560, p = 0.011).
Interpretation
The findings suggest that SPS is an independent risk factor for AKI after CABG, which aligns with previous literature indicating a link between glomerular filtration abnormalities and kidney injury. The effect size, while statistically significant, may not be clinically meaningful given the overlapping confidence intervals. Limitations such as the retrospective design and potential confounding factors could affect the robustness of the conclusions drawn from this study.
Key findings
- 23.2% incidence of postoperative AKI overall, n=1277.
- 12.8% of patients diagnosed with SPS before surgery, n=1277.
- 33.5% incidence of AKI in the SPS group vs. 21.7% in the non-SPS group, adjOR = 1.613, 95%CI 1.121-2.322, p = 0.010.
- After propensity score matching, AKI incidence in SPS group was 33.5% vs. 22.9% in non-SPS group, adjOR = 1.702, 95%CI 1.131-2.560, p = 0.011.
Limitations
- Retrospective cohort design.
- Single-center study may limit generalizability.
- Potential confounding factors not controlled for.
- No long-term follow-up data reported.