George J. Arnaoutakis, Tomas D. Martin, Phillip J. Hess, Charles T. Klodell, Curtis G. Tribble, Cyndi Garvan, Thomas M. Beaver; Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL
Objective: A new international consensus definition for renal injury (RIFLE= Risk, Injury, Failure, Loss, Endstage) has been introduced. Predictors for renal dysfunction were identified employing RIFLE criteria in patients undergoing deep hypothermic circulatory arrest (DHCA) for aortic arch reconstruction.Methods: Single center, retrospective cohort study of 269 patients undergoing aortic arch surgery with DHCA between July 2001 and October 2005. Univariate and known predictors for renal dysfunction (age, baseline GFR, surgery status, redo, bypass and cross-clamp time, diabetes, hypertension, pRBCS) were employed in a multivariate regression model to identify predictors for RIFLE renal dsyfunction categories I (Injury) or F (Failure) and Endstage dialysis.
Results: Mean age was 64 (range 23-89) with 169 males (63%). Forty-five (16.7%) had RIFLE scores of I or F, and 22 (8.2%) required dialysis. Twelve (54.5%) dialysis patients died. Predictors for RIFLE scores of I or F were emergency surgery, OR=2.241 (95% CI, 1.045-4.809), pRBCs, OR=1.137 (95% CI, 1.063-1.216) and age, OR=1.050 (95% CI, 1.014-1.087). Predictors for dialysis were baseline GFR less than 60, OR=3.968 (95% CI, 1.288-12.221), emergency surgery, OR=3.267 (95% CI, 1.080-9.886), pRBCs OR=1.278 (95% CI, 1.161-1.406) and redo surgery OR=0.026 (95% CI, 0.001-0.480). The percentage of patients in each RIFLE stratification proceeding to dialysis and mortality are depicted in Table 1.
Conclusion: RIFLE stratification predicted progression to dialysis and mortality and should be employed in future studies of renal dysfunction in aortic surgery.
Table 1. Group Outcomes According to RIFLEa Classification
a Risk, Injury, Failure, Loss, and End-stage kidney disease. b RIFLE scores available for 256 patients. c RIFLE scores were available for 21 of 22 patients who required dialysis.
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