초록접수 현황
| 16F-120 | 구연 발표 |
Effect of Saline-liberal vs -restrictive Administration on Acute Kidney Injury after Cardiac Surgery
Pil Je Kang, Young Woong Kim, Eun Ji Park, Joon Bum Kim, Sung Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee, Ju Yong Lim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Background : Intravenous 0.9% saline administration is very common in the intensive care unit (ICU) following cardiac surgery to maintain adequate cardiac output. As the patients who undergo cardiac surgery using cardiopulmonary bypass (CPB) become vulnerable to acute kidney injury (AKI), liberal use of saline which has rich chloride may precipitate postoperative AKI. However, there is lack of data. Aim of this study is to determine the effect of saline-liberal vs -restrictive administration on AKI after cardiac surgery.
Methods : Retrospective cohort study of patients who admitted to the cardiovascular surgery ICU (CSICU) following cardiac surgery from January 2014 to December 2015 was performed. Patients who were on renal replacement therapy before surgery or who underwent surgery without CPB were excluded. As saline and a balanced solution (Plasma Solution A) have been used mainly in the CSICU, patients were divided into saline-liberal (>1 liter) vs –restrictive groups (≤1) according to the amount of administered saline during the first 48 hours postoperatively. Primary outcome was the incidence of AKI, defined as the risk, injury, failure, loss, end-stage (RIFLE) classification. Logistic regression model and propensity score matching were used for analysis.
Results : 1,761 patients were included in the study, of which 331 (18.7%) belonged to saline-liberal group, and 1430 (81.2%) saline-restrictive. AKI developed in 11.7% patients without any difference between groups (12.7% vs 11.5%). Saline-liberal administration did not increase the risk of AKI in the multivariate analysis (OR 1.03, 95% CI 0.67-1.57, p=0.89). Propensity score matched data adjusted by covariates (CPB time, postoperative transfusion and ECMO insertion, and postoperative re-exploration for bleeding) also showed that liberal administration of saline was not associated with increased risk of AKI (OR 0.95, 95% CI 0.61-1.46, p=0.81).
Conclusion : Liberal administration of saline in the postoperative period following cardiac surgery may not increase the risk of AKI. Further randomized study is needed.
Methods : Retrospective cohort study of patients who admitted to the cardiovascular surgery ICU (CSICU) following cardiac surgery from January 2014 to December 2015 was performed. Patients who were on renal replacement therapy before surgery or who underwent surgery without CPB were excluded. As saline and a balanced solution (Plasma Solution A) have been used mainly in the CSICU, patients were divided into saline-liberal (>1 liter) vs –restrictive groups (≤1) according to the amount of administered saline during the first 48 hours postoperatively. Primary outcome was the incidence of AKI, defined as the risk, injury, failure, loss, end-stage (RIFLE) classification. Logistic regression model and propensity score matching were used for analysis.
Results : 1,761 patients were included in the study, of which 331 (18.7%) belonged to saline-liberal group, and 1430 (81.2%) saline-restrictive. AKI developed in 11.7% patients without any difference between groups (12.7% vs 11.5%). Saline-liberal administration did not increase the risk of AKI in the multivariate analysis (OR 1.03, 95% CI 0.67-1.57, p=0.89). Propensity score matched data adjusted by covariates (CPB time, postoperative transfusion and ECMO insertion, and postoperative re-exploration for bleeding) also showed that liberal administration of saline was not associated with increased risk of AKI (OR 0.95, 95% CI 0.61-1.46, p=0.81).
Conclusion : Liberal administration of saline in the postoperative period following cardiac surgery may not increase the risk of AKI. Further randomized study is needed.
책임저자: Ju Yong Lim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Ju Yong Lim, E-mail : millalim92@gmail.com