Original ArticlesAcute Kidney Injury

Sex and the Risk of AKI Following Cardio-thoracic Surgery: A Meta-Analysis

Joel Neugarten, Sandipani Sandilya, Beenu Singh and Ladan Golestaneh
CJASN December 2016, 11 (12) 2113-2122; DOI: https://doi.org/10.2215/CJN.03340316

Abstract

Background and objectives Being a woman is a well established risk factor for the development of cardiothoracic surgery–associated AKI. In striking contrast, women are less likely to develop AKI associated with noncardiac surgical procedures than men. In an attempt to ascertain why being a woman might be protective for ischemic AKI after general surgery but deleterious in patients undergoing cardiothoracic surgery, we examined cardiothoracic surgery–associated AKI in greater detail.

Design, setting, participants, & measurements We performed a systematic review and meta-analysis of cardiothoracic surgery–associated AKI studies published between January of 1978 and December of 2015 to further explore the relationship between sex and cardiothoracic surgery–associated AKI.

Results Sixty-four studies were identified that provided sex-specific data regarding the incidence of cardiothoracic surgery–associated AKI among 1,057,412 subjects. Using univariate analysis, women were more likely than men to develop AKI postoperatively (odds ratio, 1.21; 95% confidence interval, 1.09 to 1.33; P<0.001). However, when the analysis was restricted to the 120,464 subjects reported in 29 studies that used the Acute Kidney Injury Network criteria, the RIFLE criteria, or the Kidney Disease Improving Global Outcomes criteria to define AKI, there was no significant sex–related difference in risk. Seventeen studies used multivariate analysis to assess risk factors for cardiothoracic surgery–associated AKI and provided sex–specific odd ratios. Among the 1,587,181 individuals included in these studies, the risk of developing cardiothoracic surgery–associated AKI was not significantly associated with sex (odds ratio, 1.04; 95% confidence interval, 0.92 to 1.19; P=0.51). However, when the analysis was restricted to the 5106 subjects reported in four studies that used the Acute Kidney Injury Network criteria to define AKI, the risk of developing AKI was significantly lower in women compared with in men (odds ratio, 0.75; 95% confidence interval, 0.65 to 0.87; P<0.001).

Conclusions Our systematic review and meta-analysis contradict the generally held consensus that being a woman is an independent risk factor for the development of cardiothoracic surgery–associated AKI.

Introduction

Sex dimorphism is a well recognized feature of chronic progressive kidney disease (1). Being a woman is thought to play a protective role, mediated by differences in the hormonal milieu (1). Although less well appreciated, sex dimorphism has also been clearly established in the development of ischemic AKI (2). There is a lower incidence of AKI after noncardiac surgery in women compared with men (3–5). In striking contrast, being a woman has repeatedly been identified as predicting the development of cardiothoracic surgery–associated AKI (CSAKI) as well as the increased morbidity and mortality associated with this complication (6–21). The Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury consensus report clearly recognizes the association between women and an increased risk for CSAKI (22). The vast majority of review articles written on the subject also identify women as being at greater risk for CSAKI (6–21). Moreover, several cardiovascular surgery renal risk stratification algorithms developed to assess the preoperative risk of CSAKI include women as a risk factor (23–25). In an attempt to ascertain why being a woman might be protective in patients undergoing general surgical procedures but detrimental in patients undergoing cardiothoracic surgery, we examined CSAKI in greater detail by performing a systematic review and meta-analysis of CSAKI studies published between January of 1978 and December of 2015.

Materials and Methods

Search Strategy and Selection Criteria

We conducted a systematic review and meta-analysis of the English literature to evaluate the reported incidence of AKI after cardiac surgery in men and women (Figure 1). This systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol (26).

Figure 1.
Figure 1.

Identification of studies for meta-analysis.

We searched PubMed and EMBASE for English language articles published between January 1, 1978 and January 1, 2015. The following medical subject heading terms were used: cardiac surgery, cardiothoracic surgery, cardiovascular surgery, heart surgery, AKI, acute renal failure, and acute renal insufficiency. We also examined the references of the articles that were recovered for additional resources and included those studies that satisfied the inclusion criteria. At least two reviewers independently reviewed titles and abstracts of the articles that were found in the database searches to identify eligible studies. Full text versions of the selected studies were analyzed in detail. Any case-control or cohort study of subjects who underwent cardiothoracic surgery (coronary artery bypass graft [CABG], thoracic aorta, and/or cardiac valve surgery) was eligible. We only included studies that reported data on the incidence of AKI in men versus women. We excluded studies in subjects <18 years of age, studies in which the sample size was <500 patients, and studies in which <15% of the patients were women. We also excluded studies of subjects that underwent cardiac transplant surgery or endovascular repair of cardiac valves.

Definition of AKI

We accepted studies that defined AKI by investigator-created criteria, the Acute Kidney injury Network (AKIN) criteria, the KDIGO criteria, the RIFLE criteria, or the requirement for RRT (22,27,28). Investigator-created criteria for AKI included a specified increase in the serum creatinine level, a specified decline in calculated GFR, or a combination of these criteria. The primary outcome was defined as AKI after cardiac surgery by any of these definitions.

Data Extraction

All studies were examined for duplication of data. Attention was given to the reporting clinical center, years covered, and overlap with larger regional or national databases. If there was an estimated overlap of 33% or more of individuals between any two studies, the smaller study was excluded. To determine study quality, the studies were independently assessed by the authors using the Newcastle Ottawa Score for cohort and case-control studies (29). Disagreements on the scores of individual studies were resolved by discussion. Studies with scores less than six were excluded from the final analysis.

Statistical Analyses

Data were analyzed using a random effects model with RevMan, version 5.3 (The Cochrane Collaboration). We analyzed separately studies that used univariate versus multivariate analysis.

Results

Sixty-four studies were identified that provided sex-specific data regarding the incidence of AKI associated with cardiothoracic surgery among 1,057,412 patients (293,689 women and 763,723 men) (11,23–25,30–89). Seventeen studies included only patients who underwent isolated coronary artery bypass grafting, and two studies included only subjects who underwent isolated valvular surgery, whereas the remaining 45 studies included a mixture of subjects who underwent isolated or combined procedures. AKI was defined by the RIFLE criteria in 12 studies, the AKIN criteria in 11 studies, the KDIGO criteria in six studies, the need for RRT in 11 studies, and investigator-defined criteria in the remaining 24 studies. Women were more likely than men to develop CSAKI (odds ratio [OR], 1.21; 95% confidence interval [95% CI], 1.09 to 1.33; P<0.001) (Figures 2 and 3). When the analysis was restricted to the 57,259 subjects reported in 11 studies that used the need for RRT to define AKI, women were at even greater risk to develop CSAKI compared with the full cohort (OR, 1.70; 95% CI, 1.19 to 2.44; P=0.004). In the RRT subset, the incidence of CSAKI among women was 4.2% (695 of 16,554) compared with 2.6% among men (1056 of 40,705). In contrast, when the analysis was restricted to the 22,062 subjects reported in the 12 studies that used the RIFLE criteria to define AKI, the risk of developing CSAKI was not significantly influenced by sex (OR, 1.11; 95% CI, 0.97 to 1.27; P=0.13). In the RIFLE subset, the incidence of CSAKI among women was 26.0% (1758 of 6763) compared with 24.3% among men (3720 of 15,299). Similarly, when the analysis was restricted to the 69,438 patients reported in the 11 studies that used the AKIN criteria to define AKI, the risk of developing CSAKI was not significantly influenced by sex (OR, 0.94; 95% CI, 0.81 to 1.09; P=0.38). In the AKIN subset, the incidence of CSAKI among women was 9.1% (1728 of 18,914) compared with 10.1% among men (5118 of 50,524). When the analysis was restricted to the 28,964 individuals reported in the six studies that used the KDIGO criteria to define AKI, the risk of developing CSAKI was again not significantly influenced by sex (OR, 0.84; 95% CI, 0.66 to 1.07; P=0.16). In the KDIGO subset, the incidence of CSAKI among women was 27.0% (2226 of 8231) compared with 28.5% among men (5903 of 20,733).

Figure 2.
Figure 2.

Increased AKI risk for women in 64 studies with sex-specific data. 95% CI, 95% confidence interval; M.H., Mantel Haenszel.

Figure 3.
Figure 3.

High variability amongst 64 studies with sex-specific data. Each circle represents a separate study.

Fifty-five studies were identified that used multivariate analysis to evaluate the factors that contributed to CSAKI, with sex as one of the independent variables (11,23,25,30,31,33–35,38–43,45–50,52,54,55,57,58,60–64,66,68,71–73,75,77,80,83,85,86,89–102); 17 of these 55 studies provided sex-specific ORs (23,25,35,45,48,63,64,75,89,95–102). Individual studies evaluated a number of covariates that might interact with sex to influence the development of CSAKI. These covariates included age (100% of studies); ejection fraction or history of congestive heart failure (100%); history of diabetes mellitus (100%); reoperation (92%); type of surgical procedure (89%); baseline renal function (83%); history of hypertension (75%); prior myocardial infarction (58%); cardiopulmonary bypass time (58%); body mass index, body surface area, or weight (58%); hemoglobin level, transfusion requirement, or estimated blood loss (50%); use of intra–aortic balloon pump (50%); crossclamp time (50%); smoking (25%); use of angiotensin–converting enzyme inhibitors or angiotensin receptor blockers (8%); statin use (8%); and diuretic use (8%). Four studies included only subjects who underwent isolated coronary artery bypass grafting, and two studies included only subjects who underwent isolated cardiac valve or aortic surgery, whereas the remaining 11 studies included a mixture of subjects who underwent isolated or combined procedures. AKI was defined by the RIFLE criteria in one study, the AKIN criteria in four studies, the KDIGO criteria in two studies, the need for RRT in five studies, and investigator-defined criteria in the remaining five studies. The total group included 1,587,181 patients (473,269 women and 1,113,912 men). In this cohort, the risk of developing CSAKI was not significantly influenced by sex (OR, 1.04; 95% CI, 0.92 to 1.19; P=0.51) (Figure 4). In contrast, when the analysis was restricted to the 5106 subjects reported in four studies that used the AKIN criteria to define AKI, the risk of developing CSAKI was significantly lower in women compared with men (OR, 0.75; 95% CI, 0.65 to 0.87; P<0.001). Only three studies provided ORs for AKI stratified by stage.

Figure 4.
Figure 4.

No difference in sex-specific odds ratio in multivariate studies analyzed. 95% CI, 95% confidence interval; IV, inverse variance.

We observed a high degree of statistical heterogeneity in our meta-analyses (univariate: I2=94%; multivariate: I2=95%). However, statistical heterogeneity was entirely eliminated among studies that used multivariate analysis and defined AKI by the AKIN criteria (I2=0%). Among studies that used univariate analysis and defined AKI by the KDIGO criteria, statistical heterogeneity was low (I2=21%). Absent one outlier, the degree of statistical heterogeneity was moderate among studies that used univariate analysis and defined AKI by the KDIGO criteria (I2=41%). The same was true among studies that used univariate analysis and defined AKI by the AKIN criteria (I2=59%).

Thirty-eight of the 55 studies that used multivariate analysis evaluated the effect of sex on the risk of CSAKI but failed to provide sex-specific ORs (11,30,31,33,34,38–43,46,47,49,50,52,54,55,57,58,60–62,66,68,71–73,77,80,83,85,86,90–94). AKI was defined by the RIFLE criteria in 10 studies, the AKIN criteria in six studies, the KDIGO criteria in one study, the need for RRT in four studies, and investigator-defined criteria in the remaining 17 studies. This cohort included 101,835 patients (27,115 women and 74,720 men). All 38 studies failed to find any significant effect of sex on the incidence of CSAKI.

Discussion

Sex dimorphism is a well recognized feature of chronic progressive kidney disease (1). Although less well appreciated, sex dimorphism has also been clearly established in ischemic AKI (2). Large epidemiologic studies show that women exhibit a lower incidence of AKI after noncardiac surgery (3–5,103–106). Kheterpal et al. (5) used data from 57,075 general surgery procedures performed in the United States between 2005 and 2006 to create an AKI preoperative risk stratification model. In this analysis, being a man was found to be an independent predictor of AKI (OR, 1.4; 95% CI, 1.2 to 1.7). Grams et al. (4) analyzed 161,185 veterans (96.3% men) who underwent major surgery (including cardiac surgery) between 2004 and 2011 and found being a man to be an independent risk factor for AKI defined by the KDIGO criteria, by univariate analysis as well as in a fully adjusted model.

AKI is an important complication of cardiothoracic surgery that confers substantial additional morbidity and mortality (6–21). Before the development of standardized criteria to define AKI, this complication was reported in 0.3%–40% of patients depending on the definition of AKI used by the investigator, the complexity of the surgical procedures, and the prevalence of preexisting risk factors in the study population (6–21). AKI requiring RRT was reported to occur in 0.37%–5% of patients (6–21). Numerous investigators have attempted to identify risk factors that predispose to the development CSAKI. Risk factors that have repeatedly been identified include baseline renal function, the type and complexity of the surgical procedure, age, women, emergency surgery, prior cardiac surgery, reoperation, need for intra–aortic balloon pump, cardiogenic shock, the length of cardiopulmonary bypass, and comorbidities, such as insulin–requiring diabetes mellitus, peripheral vascular disease, congestive heart failure, and chronic obstructive lung disease (6–21). More recently, investigators have identified preoperative hemoglobin, nadir hemoglobin during cardiopulmonary bypass, and the number of blood transfusions as additional risk factors (50,57,88,107–109). More controversial are the roles played by on- versus off-pump surgery and aprotinin use (41).

Being a woman has repeatedly been identified in these studies as an independent risk factor for the development of CSAKI as well as the increased morbidity and mortality associated with this complication (6–21). Most review articles dealing with CSAKI recognize being a woman as an independent risk factor for its development on the basis of retrospective and prospective studies, local databases, and national and international registry data (6–21). The Nephrology Self-Assessment Program identifies “demographic factors such as female gender…as independent risk factors of [cardiovascular surgery–associated] AKI” (110). In addition, the KDIGO consensus statement clearly recognizes being a woman as an important risk factor for CSAKI (22). In this context, several cardiovascular surgery renal risk stratification algorithms have been developed to assess the preoperative risk of CSAKI. Three prominent scoring systems include being a woman as a risk factor for AKI (23–25). In contrast, several other CSAKI risk algorithms do not include sex as a risk factor (34,47,72,75,83,90), and two scoring systems recognize being a woman as renoprotective (35,111).

Among the difficulties in comparing data from the various studies of CSAKI are the differing criteria used to define AKI. Although many studies used investigator-created criteria, others used the RIFLE, the AKIN, or the KDIGO criteria. The need for RRT is an inadequate end point to define CSAKI because of subjectivity inherent in the decision to initiate dialysis (24,112,113). In a cohort of patients with AKI who underwent propensity score matching, Wilson et al. (113) found that dialysis was more likely to be initiated in women than in men. Noyez (92) applied five different investigator–created definitions of AKI obtained from the published literature to his patient cohort and found that the incidence of CSAKI varied between 4.9% and 38.1% depending on the definition used. Sex was found to predict CSAKI by univariate analysis using one of the definitions of AKI, but it was not found to predict CSAKI when the other definitions were substituted. Similarly, we found that the incidence of CSAKI varied widely depending on the definition used. AKI complicated cardiothoracic surgery in 5.3% of patients when all studies were combined, 28.2% of patients in those studies in which the RIFLE criteria are used, 14.0% of patients in those studies in which the AKIN criteria are used, and 26.6% of patients in those studies that used the KDIGO criteria. RRT was required in 3.1% of patients.

When we combined all studies that provided sex-specific data for univariate analysis, irrespective of the definition of CSAKI used, being a woman increased the risk of CSAKI. In contrast, being a woman was not a risk factor in those studies in which the RIFLE, the AKIN, or the KDIGO criteria were used to define CSAKI. Focusing solely on those studies that used multivariate analysis to assess CSAKI risk, when we combined all studies irrespective of the definition of CSAKI used, we found no association between sex and AKI risk. However, being a woman was found to be renoprotective by multivariate analysis in those studies that used the AKIN criteria to define CSAKI.

These disparate conclusions may merely reflect the differing definitions of CSAKI, because the criteria used to define AKI clearly influence the outcome. Alternatively, this simple explanation may mask more complex interactions between sex and cardiovascular surgery outcomes. Moreover, failure of the covariates used in multivariate analyses to capture these interactions may obscure the true relationship between sex and CSAKI. Most studies have shown that women present for cardiovascular surgery with a higher burden of comorbidities and worse cardiovascular status than men (36,88,102,114–117). This disparity may arise from sex-based biases in the delivery of health care or because of a more aggressive course of cardiac disease in women (102). It has been suggested that referral bias leads women to undergo coronary artery revascularization or cardiac valve surgery at a more advanced stage of disease (102,114). Women undergoing cardiovascular surgery also show a higher prevalence of risk factors that have been associated with a poor outcome. An analysis of the Society of Thoracic Surgery National Database reported that women undergoing coronary artery bypass grafting surgery between 1994 and 1996 were older; had a higher prevalence of comorbidities, such as diabetes mellitus, hypertension, and peripheral vascular disease; and were more likely to undergo nonelective emergency procedures and more complicated valve surgeries than men (114). Examination of a subset of the same database for the years 1996 and 1997 showed that women were older and more likely to have diabetes and hypertension but less likely to have smoked or have triple-vessel disease than men (88,115). Mehta et al. (88) also reported that women undergoing cardiovascular surgery showed a higher risk profile than men because of more advanced age; lower body surface area and preoperative hematocrit; greater prevalence of congestive heart failure, cardiogenic shock, recent myocardial infarction, unstable angina, and shock; and increased likelihood of undergoing reoperation or high-risk procedures requiring longer cardiopulmonary bypass time and increased numbers of transfusions.

Nadir hematocrit during cardiopulmonary bypass has recently been identified as an additional independent risk factor for CSAKI (50,88,108,109). Women exhibit lower preoperative hematocrit levels and because of their smaller body surface area, experience greater hemodilution during cardiopulmonary bypass, resulting in a lower nadir hematocrit (88,108). Paradoxically, at the lowest nadir hematocrit levels, women have a lower risk of CSAKI than men, suggesting that women may tolerate severe hemodilution better than men (88). Because of lower nadir hematocrit levels, women are also more likely to undergo a blood transfusion, which itself is an established independent risk factor for CSAKI (118). Adding further complexity to these interactions, the greater hemodilution that women experience in the perioperative setting may, in turn, reduce the rate of detection of AKI in women compared with men (119).

Being a woman was associated with a reduced risk of CSAKI among 503,478 subjects who underwent isolated CABG between the years 1997 and 1999 as reported in a multivariate analysis of The Society of Thoracic Surgeons National Adult Cardiac Surgery Database (OR, 0.94; 95% CI, 0.89 to 1.00), whereas being a woman was associated with an increased risk of CSAKI among 774,881 subjects entered into the same registry who underwent isolated CABG between 2002 and 2006 (OR, 1.25; 95% CI, 1.21 to 1.31) (89,100) These discrepant data from the same registry are consistent with our conclusion that sex is not an independent risk factor for the development of CSAKI. Although differing criteria to define CSAKI may explain these inconsistent data, clearly, the anatomic and physiologic differences between the sexes did not change between the years 1997–1999 and 2002–2006. We believe that factors related to but not inherent in one’s sex are responsible for these differing outcomes. We point to difficulties in accurately quantifying differences in the severity of comorbidities and other preoperative risk factors that may not be adequately captured in the covariates used in the multivariate analyses.

In conclusion, our meta-analysis contradicts the generally held consensus that being a woman is an independent risk factor for the development of CSAKI. These disparate results may merely reflect different definitions of CSAKI. However, this simple explanation may mask more complex interactions between sex and cardiovascular surgery. We believe that factors related to but not inherent in one’s sex may be responsible for and reflect a greater burden of comorbidities in women undergoing cardiovascular surgery because of disparities in health care delivery or a more aggressive course of cardiovascular disease in women.

Disclosures

None.

Footnotes

  • Published online ahead of print. Publication date available at www.cjasn.org.

  • Received March 23, 2016.
  • Accepted August 16, 2016.

References

  1. ↵
    1. Neugarten J,
    2. Golestaneh L
    : Gender and the prevalence and progression of renal disease. Adv Chronic Kidney Dis 20: 390–395, 2013pmid:23978543
    OpenUrlCrossRefPubMed
  2. ↵
    1. Hutchens MP,
    2. Dunlap J,
    3. Hurn PD,
    4. Jarnberg PO
    : Renal ischemia: Does sex matter? Anesth Analg 107: 239–249, 2008pmid:18635495
    OpenUrlCrossRefPubMed
  3. ↵
    1. Bell S,
    2. Dekker FW,
    3. Vadiveloo T,
    4. Marwick C,
    5. Deshmukh H,
    6. Donnan PT,
    7. Van Diepen M
    : Risk of postoperative acute kidney injury in patients undergoing orthopaedic surgery--development and validation of a risk score and effect of acute kidney injury on survival: Observational cohort study. BMJ 351: h5639, 2015pmid:26561522
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Grams ME,
    2. Sang Y,
    3. Coresh J,
    4. Ballew S,
    5. Matsushita K,
    6. Molnar MZ,
    7. Szabo Z,
    8. Kalantar-Zadeh K,
    9. Kovesdy CP
    : Acute kidney injury after major surgery: A retrospective analysis of Veterans Health Administration data. Am J Kidney Dis 67: 872–880, 2016pmid:26337133
    OpenUrlCrossRefPubMed
  5. ↵
    1. Kheterpal S,
    2. Tremper KK,
    3. Heung M,
    4. Rosenberg AL,
    5. Englesbe M,
    6. Shanks AM,
    7. Campbell DA Jr..
    : Development and validation of an acute kidney injury risk index for patients undergoing general surgery: Results from a national data set. Anesthesiology 110: 505–515, 2009pmid:19212261
    OpenUrlCrossRefPubMed
  6. ↵
    1. Arora P,
    2. Kolli H,
    3. Nainani N,
    4. Nader N,
    5. Lohr J
    : Preventable risk factors for acute kidney injury in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 26: 687–697, 2012pmid:22516466
    OpenUrlCrossRefPubMed
    1. Ihle BU
    : Acute renal dysfunction after cardiac surgery: Still a big problem! Heart Lung Circ 16[Suppl 3]: S39–S44, 2007pmid:17616436
    OpenUrlPubMed
    1. Kumar AB,
    2. Suneja M
    : Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology 114: 964–970, 2011pmid:21394005
    OpenUrlCrossRefPubMed
    1. Mao H,
    2. Katz N,
    3. Ariyanon W,
    4. Blanca-Martos L,
    5. Adýbelli Z,
    6. Giuliani A,
    7. Danesi TH,
    8. Kim JC,
    9. Nayak A,
    10. Neri M,
    11. Virzi GM,
    12. Brocca A,
    13. Scalzotto E,
    14. Salvador L,
    15. Ronco C
    : Cardiac surgery-associated acute kidney injury. Blood Purif 37[Suppl 2]: 34–50, 2014pmid:25196567
    OpenUrlCrossRefPubMed
    1. Mariscalco G,
    2. Lorusso R,
    3. Dominici C,
    4. Renzulli A,
    5. Sala A
    : Acute kidney injury: A relevant complication after cardiac surgery. Ann Thorac Surg 92: 1539–1547, 2011pmid:21872837
    OpenUrlCrossRefPubMed
  11. ↵
    1. Najjar M,
    2. Salna M,
    3. George I
    : Acute kidney injury after aortic valve replacement: Incidence, risk factors and outcomes. Expert Rev Cardiovasc Ther 13: 301–316, 2015pmid:25592763
    OpenUrlCrossRefPubMed
    1. Olivero JJ,
    2. Olivero JJ,
    3. Nguyen PT,
    4. Kagan A
    : Acute kidney injury after cardiovascular surgery: An overview. Methodist DeBakey Cardiovasc J 8: 31–36, 2012pmid:23227284
    OpenUrlCrossRefPubMed
    1. Parida S,
    2. Badhe AS
    : Cardiac surgery-associated acute kidney injury. J Anesth 27: 433–446, 2013pmid:23179740
    OpenUrlCrossRefPubMed
    1. Ranucci M
    : Perioperative renal failure: Hypoperfusion during cardiopulmonary bypass? Semin Cardiothorac Vasc Anesth 11: 265–268, 2007pmid:18270190
    OpenUrlCrossRefPubMed
    1. Romagnoli S,
    2. Ricci Z
    : Postoperative acute kidney injury. Minerva Anestesiol 81: 684–696, 2015pmid:25057935
    OpenUrlPubMed
    1. Rosner MH,
    2. Okusa MD
    : Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 1: 19–32, 2006pmid:17699187
    OpenUrlAbstract/FREE Full Text
    1. Rosner MH,
    2. Portilla D,
    3. Okusa MD
    : Cardiac surgery as a cause of acute kidney injury: Pathogenesis and potential therapies. J Intensive Care Med 23: 3–18, 2008pmid:18230632
    OpenUrlCrossRefPubMed
    1. Stafford-Smith M,
    2. Patel UD,
    3. Phillips-Bute BG,
    4. Shaw AD,
    5. Swaminathan M
    : Acute kidney injury and chronic kidney disease after cardiac surgery. Adv Chronic Kidney Dis 15: 257–277, 2008pmid:18565477
    OpenUrlCrossRefPubMed
    1. Thakar CV
    : Perioperative acute kidney injury. Adv Chronic Kidney Dis 20: 67–75, 2013pmid:23265598
    OpenUrlCrossRefPubMed
    1. Thiele RH,
    2. Isbell JM,
    3. Rosner MH
    : AKI associated with cardiac surgery. Clin J Am Soc Nephrol 10: 500–514, 2015pmid:25376763
    OpenUrlAbstract/FREE Full Text
  21. ↵
    1. Vives M,
    2. Wijeysundera D,
    3. Marczin N,
    4. Monedero P,
    5. Rao V
    : Cardiac surgery-associated acute kidney injury. Interact Cardiovasc Thorac Surg 18: 637–645, 2014pmid:24535092
    OpenUrlCrossRefPubMed
  22. ↵
    1. KDIGO
    : KDIGO clinical practice guidelines for acute kidney injury. Kidney Int 2[Suppl 1]: 1–138, Online Appendices A–F, 2012. Accessed September 1, 2016
  23. ↵
    1. Brown JR,
    2. Cochran RP,
    3. Leavitt BJ,
    4. Dacey LJ,
    5. Ross CS,
    6. MacKenzie TA,
    7. Kunzelman KS,
    8. Kramer RS,
    9. Hernandez F Jr..,
    10. Helm RE,
    11. Westbrook BM,
    12. Dunton RF,
    13. Malenka DJ,
    14. O’Connor GT; Northern New England Cardiovascular Disease Study Group
    : Multivariable prediction of renal insufficiency developing after cardiac surgery. Circulation 116[Suppl]: I139–I143, 2007pmid:17846294
    OpenUrlPubMed
  24. ↵
    1. Thakar CV,
    2. Liangos O,
    3. Yared JP,
    4. Nelson DA,
    5. Hariachar S,
    6. Paganini EP
    : Predicting acute renal failure after cardiac surgery: Validation and re-definition of a risk-stratification algorithm. Hemodial Int 7: 143–147, 2003pmid:19379354
    OpenUrlCrossRefPubMed
  25. ↵
    Ng SY, Sanagou M, Wolfe R, Cochrane A, Smith JA, Reid CM: Prediction of acute kidney injury within 30 days of cardiac surgery. J Thorac Cardiovasc Surg 147: 1875–1883.e1, 2014
  26. ↵
    1. Hutton B,
    2. Salanti G,
    3. Caldwell DM,
    4. Chaimani A,
    5. Schmid CH,
    6. Cameron C,
    7. Ioannidis JP,
    8. Straus S,
    9. Thorlund K,
    10. Jansen JP,
    11. Mulrow C,
    12. Catalá-López F,
    13. Gøtzsche PC,
    14. Dickersin K,
    15. Boutron I,
    16. Altman DG,
    17. Moher D
    : The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Ann Intern Med 162: 777–784, 2015pmid:26030634
    OpenUrlCrossRefPubMed
  27. ↵
    1. Mehta RL,
    2. Kellum JA,
    3. Shah SV,
    4. Molitoris BA,
    5. Ronco C,
    6. Warnock DG,
    7. Levin A; Acute Kidney Injury Network
    : Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 11: R31, 2007pmid:17331245
    OpenUrlCrossRefPubMed
  28. ↵
    1. Bellomo R,
    2. Ronco C,
    3. Kellum JA,
    4. Mehta RL,
    5. Palevsky P; Acute Dialysis Quality Initiative workgroup
    : Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8: R204–R212, 2004pmid:15312219
    OpenUrlCrossRefPubMed
  29. ↵
    Wells GASB, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P: The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Available at: http://wwwohrica/programsclinical_epidemiology/oxfordasp. Accessed September 1, 2016
  30. ↵
    1. Andersson LG,
    2. Ekroth R,
    3. Bratteby LE,
    4. Hallhagen S,
    5. Wesslén O
    : Acute renal failure after coronary surgery--a study of incidence and risk factors in 2009 consecutive patients. Thorac Cardiovasc Surg 41: 237–241, 1993pmid:8211928
    OpenUrlCrossRefPubMed
  31. ↵
    1. Arora P,
    2. Rajagopalam S,
    3. Ranjan R,
    4. Kolli H,
    5. Singh M,
    6. Venuto R,
    7. Lohr J
    : Preoperative use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers is associated with increased risk for acute kidney injury after cardiovascular surgery. Clin J Am Soc Nephrol 3: 1266–1273, 2008pmid:18667735
    OpenUrlAbstract/FREE Full Text
    1. Bahar I,
    2. Akgul A,
    3. Ozatik MA,
    4. Vural KM,
    5. Demirbag AE,
    6. Boran M,
    7. Tasdemir O
    : Acute renal failure following open heart surgery: Risk factors and prognosis. Perfusion 20: 317–322, 2005pmid:16363316
    OpenUrlCrossRefPubMed
  33. ↵
    1. Benedetto U,
    2. Angeloni E,
    3. Luciani R,
    4. Refice S,
    5. Stefanelli M,
    6. Comito C,
    7. Roscitano A,
    8. Sinatra R
    : Acute kidney injury after coronary artery bypass grafting: Does rhabdomyolysis play a role? J Thorac Cardiovasc Surg 140: 464–470, 2010pmid:20416892
    OpenUrlCrossRefPubMed
  34. ↵
    1. Berg KS,
    2. Stenseth R,
    3. Wahba A,
    4. Pleym H,
    5. Videm V
    : How can we best predict acute kidney injury following cardiac surgery?: A prospective observational study. Eur J Anaesthesiol 30: 704–712, 2013pmid:24067536
    OpenUrlCrossRefPubMed
  35. ↵
    1. Birnie K,
    2. Verheyden V,
    3. Pagano D,
    4. Bhabra M,
    5. Tilling K,
    6. Sterne JA,
    7. Murphy GJ; UK AKI in Cardiac Surgery Collaborators
    : Predictive models for kidney disease: Improving global outcomes (KDIGO) defined acute kidney injury in UK cardiac surgery. Crit Care 18: 606, 2014pmid:25673427
    OpenUrlCrossRefPubMed
  36. ↵
    1. Brown JR,
    2. Cochran RP,
    3. Dacey LJ,
    4. Ross CS,
    5. Kunzelman KS,
    6. Dunton RF,
    7. Braxton JH,
    8. Charlesworth DC,
    9. Clough RA,
    10. Helm RE,
    11. Leavitt BJ,
    12. Mackenzie TA,
    13. O’Connor GT; Northern New England Cardiovascular Disease Study Group
    : Perioperative increases in serum creatinine are predictive of increased 90-day mortality after coronary artery bypass graft surgery. Circulation 114[Suppl]: I409–I413, 2006pmid:16820609
    OpenUrlPubMed
    1. Candela-Toha A,
    2. Elías-Martín E,
    3. Abraira V,
    4. Tenorio MT,
    5. Parise D,
    6. de Pablo A,
    7. Centella T,
    8. Liaño F
    : Predicting acute renal failure after cardiac surgery: External validation of two new clinical scores. Clin J Am Soc Nephrol 3: 1260–1265, 2008pmid:18463173
    OpenUrlAbstract/FREE Full Text
  38. ↵
    1. Che M,
    2. Li Y,
    3. Liang X,
    4. Xie B,
    5. Xue S,
    6. Qian J,
    7. Ni Z,
    8. Axelsson J,
    9. Yan Y
    : Prevalence of acute kidney injury following cardiac surgery and related risk factors in Chinese patients. Nephron Clin Pract 117: c305–c311, 2011pmid:20861652
    OpenUrlCrossRefPubMed
    1. Conlon PJ,
    2. Stafford-Smith M,
    3. White WD,
    4. Newman MF,
    5. King S,
    6. Winn MP,
    7. Landolfo K
    : Acute renal failure following cardiac surgery. Nephrol Dial Transplant 14: 1158–1162, 1999pmid:10344355
    OpenUrlCrossRefPubMed
    1. Del Duca D,
    2. Iqbal S,
    3. Rahme E,
    4. Goldberg P,
    5. de Varennes B
    : Renal failure after cardiac surgery: Timing of cardiac catheterization and other perioperative risk factors. Ann Thorac Surg 84: 1264–1271, 2007pmid:17888981
    OpenUrlCrossRefPubMed
  41. ↵
    1. Dietrich W,
    2. Busley R,
    3. Boulesteix AL
    : Effects of aprotinin dosage on renal function: An analysis of 8,548 cardiac surgical patients treated with different dosages of aprotinin. Anesthesiology 108: 189–198, 2008pmid:18212563
    OpenUrlCrossRefPubMed
    1. Doddakula K,
    2. Al-Sarraf N,
    3. Gately K,
    4. Hughes A,
    5. Tolan M,
    6. Young V,
    7. McGovern E
    : Predictors of acute renal failure requiring renal replacement therapy post cardiac surgery in patients with preoperatively normal renal function. Interact Cardiovasc Thorac Surg 6: 314–318, 2007pmid:17669854
    OpenUrlCrossRefPubMed
  43. ↵
    1. D’Onofrio A,
    2. Cruz D,
    3. Bolgan I,
    4. Auriemma S,
    5. Cresce GD,
    6. Fabbri A,
    7. Ronco C
    : RIFLE criteria for cardiac surgery-associated acute kidney injury: Risk factors and outcomes. Congest Heart Fail 16[Suppl 1]: S32–S36, 2010pmid:20653709
    OpenUrlCrossRefPubMed
    1. Ellis MC,
    2. Paugh TA,
    3. Dickinson TA,
    4. Fuller J,
    5. Chores J,
    6. Paone G,
    7. Heung M,
    8. Fliegner K,
    9. Pruitt AL,
    10. Patel HJ,
    11. Zhang M,
    12. Prager RL,
    13. Likosky DS; PERForm Registry and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
    : Nadir hematocrit on bypass and rates of acute kidney injury: Does sex matter? Ann Thorac Surg 100: 1549–1554, 2015pmid:26296273
    OpenUrlCrossRefPubMed
  45. ↵
    1. Englberger L,
    2. Suri RM,
    3. Connolly HM,
    4. Li Z,
    5. Abel MD,
    6. Greason KL,
    7. Dearani JA,
    8. Schaff HV
    : Increased risk of acute kidney injury in patients undergoing tricuspid valve surgery. Eur J Cardiothorac Surg 43: 993–999, 2013pmid:23002188
    OpenUrlCrossRefPubMed
  46. ↵
    1. Englberger L,
    2. Suri RM,
    3. Greason KL,
    4. Burkhart HM,
    5. Sundt TM 3rd.,
    6. Daly RC,
    7. Schaff HV
    : Deep hypothermic circulatory arrest is not a risk factor for acute kidney injury in thoracic aortic surgery. J Thorac Cardiovasc Surg 141: 552–558, 2011pmid:20392457
    OpenUrlCrossRefPubMed
  47. ↵
    1. Fortescue EB,
    2. Bates DW,
    3. Chertow GM
    : Predicting acute renal failure after coronary bypass surgery: Cross-validation of two risk-stratification algorithms. Kidney Int 57: 2594–2602, 2000pmid:10844629
    OpenUrlCrossRefPubMed
  48. ↵
    1. Gaudino M,
    2. Luciani N,
    3. Giungi S,
    4. Caradonna E,
    5. Nasso G,
    6. Schiavello R,
    7. Luciani G,
    8. Possati G
    : Different profiles of patients who require dialysis after cardiac surgery. Ann Thorac Surg 79: 825–829, 2005pmid:15734386
    OpenUrlCrossRefPubMed
  49. ↵
    1. Grayson AD,
    2. Khater M,
    3. Jackson M,
    4. Fox MA
    : Valvular heart operation is an independent risk factor for acute renal failure. Ann Thorac Surg 75: 1829–1835, 2003pmid:12822624
    OpenUrlCrossRefPubMed
  50. ↵
    1. Haase M,
    2. Bellomo R,
    3. Story D,
    4. Letis A,
    5. Klemz K,
    6. Matalanis G,
    7. Seevanayagam S,
    8. Dragun D,
    9. Seeliger E,
    10. Mertens PR,
    11. Haase-Fielitz A
    : Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney injury. Nephrol Dial Transplant 27: 153–160, 2012pmid:21677302
    OpenUrlCrossRefPubMed
    1. Hansen MK,
    2. Gammelager H,
    3. Jacobsen CJ,
    4. Hjortdal VE,
    5. Layton JB,
    6. Rasmussen BS,
    7. Andreasen JJ,
    8. Johnsen SP,
    9. Christiansen CF
    : Acute kidney injury and long-term risk of cardiovascular events after cardiac surgery: A population-based cohort study. J Cardiothorac Vasc Anesth 29: 617–625, 2015pmid:25575408
    OpenUrlCrossRefPubMed
  52. ↵
    1. Heringlake M,
    2. Nowak Y,
    3. Schön J,
    4. Trautmann J,
    5. Berggreen AE,
    6. Charitos EI,
    7. Paarmann H
    : Postoperative intubation time is associated with acute kidney injury in cardiac surgical patients. Crit Care 18: 547, 2014pmid:25277725
    OpenUrlCrossRefPubMed
    1. Hobson CE,
    2. Yavas S,
    3. Segal MS,
    4. Schold JD,
    5. Tribble CG,
    6. Layon AJ,
    7. Bihorac A
    : Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation 119: 2444–2453, 2009pmid:19398670
    OpenUrlAbstract/FREE Full Text
  54. ↵
    1. Janssen DP,
    2. Noyez L,
    3. van Druten JA,
    4. Skotnicki SH,
    5. Lacquet LK
    : Predictors of nephrological morbidity after coronary artery bypass surgery. Cardiovasc Surg 10: 222–227, 2002pmid:12044429
    OpenUrlCrossRefPubMed
  55. ↵
    1. Kajimoto K,
    2. Miyauchi K,
    3. Kasai T,
    4. Yanagisawa N,
    5. Yamamoto T,
    6. Kikuchi K,
    7. Nakatomi T,
    8. Iwamura H,
    9. Daida H,
    10. Amano A
    : Metabolic syndrome is an independent risk factor for stroke and acute renal failure after coronary artery bypass grafting. J Thorac Cardiovasc Surg 137: 658–663, 2009pmid:19258085
    OpenUrlCrossRefPubMed
    1. Kandler K,
    2. Jensen ME,
    3. Nilsson JC,
    4. Møller CH,
    5. Steinbrüchel DA
    : Acute kidney injury is independently associated with higher mortality after cardiac surgery. J Cardiothorac Vasc Anesth 28: 1448–1452, 2014pmid:25440657
    OpenUrlCrossRefPubMed
  57. ↵
    1. Karkouti K,
    2. Grocott HP,
    3. Hall R,
    4. Jessen ME,
    5. Kruger C,
    6. Lerner AB,
    7. MacAdams C,
    8. Mazer CD,
    9. de Medicis É,
    10. Myles P,
    11. Ralley F,
    12. Rheault MR,
    13. Rochon A,
    14. Slaughter MS,
    15. Sternlicht A,
    16. Syed S,
    17. Waters T
    : Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: A historical multicentre cohort study. Can J Anaesth 62: 377–384, 2015pmid:25537735
    OpenUrlCrossRefPubMed
  58. ↵
    1. Karkouti K,
    2. Wijeysundera DN,
    3. Yau TM,
    4. Callum JL,
    5. Cheng DC,
    6. Crowther M,
    7. Dupuis JY,
    8. Fremes SE,
    9. Kent B,
    10. Laflamme C,
    11. Lamy A,
    12. Legare JF,
    13. Mazer CD,
    14. McCluskey SA,
    15. Rubens FD,
    16. Sawchuk C,
    17. Beattie WS
    : Acute kidney injury after cardiac surgery: Focus on modifiable risk factors. Circulation 119: 495–502, 2009pmid:19153273
    OpenUrlAbstract/FREE Full Text
    1. Kiers HD,
    2. van den Boogaard M,
    3. Schoenmakers MC,
    4. van der Hoeven JG,
    5. van Swieten HA,
    6. Heemskerk S,
    7. Pickkers P
    : Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury. Nephrol Dial Transplant 28: 345–351, 2013pmid:23222415
    OpenUrlCrossRefPubMed
  60. ↵
    1. Kim WH,
    2. Park JY,
    3. Ok SH,
    4. Shin IW,
    5. Sohn JT
    : Association between the neutrophil/lymphocyte ratio and acute kidney injury after cardiovascular surgery: A retrospective observational study. Medicine (Baltimore) 94: e1867, 2015pmid:26512598
    OpenUrlCrossRefPubMed
    1. Kincaid EH,
    2. Ashburn DA,
    3. Hoyle JR,
    4. Reichert MG,
    5. Hammon JW,
    6. Kon ND
    : Does the combination of aprotinin and angiotensin-converting enzyme inhibitor cause renal failure after cardiac surgery? Ann Thorac Surg 80: 1388–1393, 2005pmid:16181876
    OpenUrlCrossRefPubMed
  62. ↵
    1. Kourliouros A,
    2. Valencia O,
    3. Phillips SD,
    4. Collinson PO,
    5. van Besouw JP,
    6. Jahangiri M
    : Low cardiopulmonary bypass perfusion temperatures are associated with acute kidney injury following coronary artery bypass surgery. Eur J Cardiothorac Surg 37: 704–709, 2010pmid:19767217
    OpenUrlCrossRefPubMed
  63. ↵
    1. Kristovic D,
    2. Horvatic I,
    3. Husedzinovic I,
    4. Sutlic Z,
    5. Rudez I,
    6. Baric D,
    7. Unic D,
    8. Blazekovic R,
    9. Crnogorac M
    : Cardiac surgery-associated acute kidney injury: Risk factors analysis and comparison of prediction models. Interact Cardiovasc Thorac Surg 21: 366–373, 2015pmid:26091696
    OpenUrlCrossRefPubMed
  64. ↵
    1. Landoni G,
    2. Zangrillo A,
    3. Franco A,
    4. Aletti G,
    5. Roberti A,
    6. Calabrò MG,
    7. Slaviero G,
    8. Bignami E,
    9. Marino G
    : Long-term outcome of patients who require renal replacement therapy after cardiac surgery. Eur J Anaesthesiol 23: 17–22, 2006pmid:16390560
    OpenUrlCrossRefPubMed
    1. Loef BG,
    2. Epema AH,
    3. Smilde TD,
    4. Henning RH,
    5. Ebels T,
    6. Navis G,
    7. Stegeman CA
    : Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 16: 195–200, 2005pmid:15563558
    OpenUrlAbstract/FREE Full Text
  66. ↵
    1. Lopez-Delgado JC,
    2. Esteve F,
    3. Torrado H,
    4. Rodríguez-Castro D,
    5. Carrio ML,
    6. Farrero E,
    7. Javierre C,
    8. Ventura JL,
    9. Manez R
    : Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: Risk factors and prognostic value of a modified RIFLE classification. Crit Care 17: R293, 2013pmid:24330769
    OpenUrlCrossRefPubMed
    1. Mangos GJ,
    2. Brown MA,
    3. Chan WY,
    4. Horton D,
    5. Trew P,
    6. Whitworth JA
    : Acute renal failure following cardiac surgery: Incidence, outcomes and risk factors. Aust N Z J Med 25: 284–289, 1995pmid:8540867
    OpenUrlCrossRefPubMed
  68. ↵
    1. Mariscalco G,
    2. Cottini M,
    3. Dominici C,
    4. Banach M,
    5. Piffaretti G,
    6. Borsani P,
    7. Bruno VD,
    8. Corazzari C,
    9. Gherli R,
    10. Beghi C
    : The effect of timing of cardiac catheterization on acute kidney injury after cardiac surgery is influenced by the type of operation. Int J Cardiol 173: 46–54, 2014pmid:24602318
    OpenUrlCrossRefPubMed
    1. McIlroy DR,
    2. Epi MC,
    3. Argenziano M,
    4. Farkas D,
    5. Umann T
    : Acute kidney injury after cardiac surgery: Does the time interval from contrast administration to surgery matter? J Cardiothorac Vasc Anesth 26: 804–812, 2012pmid:22521404
    OpenUrlCrossRefPubMed
    1. Mirmohammad-Sadeghi M,
    2. Naghiloo A,
    3. Najarzadegan MR
    : Evaluating the relative frequency and predicting factors of acute renal failure following coronary artery bypass grafting. ARYA Atheroscler 9: 287–292, 2013pmid:24302937
    OpenUrlPubMed
  71. ↵
    1. Newland RF,
    2. Tully PJ,
    3. Baker RA
    : Hyperthermic perfusion during cardiopulmonary bypass and postoperative temperature are independent predictors of acute kidney injury following cardiac surgery. Perfusion 28: 223–231, 2013pmid:23314194
    OpenUrlCrossRefPubMed
  72. ↵
    1. Palomba H,
    2. de Castro I,
    3. Neto AL,
    4. Lage S,
    5. Yu L
    : Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney Int 72: 624–631, 2007pmid:17622275
    OpenUrlCrossRefPubMed
  73. ↵
    1. Perez-Valdivieso JR,
    2. Monedero P,
    3. Vives M,
    4. Garcia-Fernandez N,
    5. Bes-Rastrollo M; GEDRCC (Grupo Español de Disfunción Renal en Cirugía Cardiaca)
    : Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study. BMC Nephrol 10: 27, 2009pmid:19772621
    OpenUrlCrossRefPubMed
    1. Perry TE,
    2. Muehlschlegel JD,
    3. Liu KY,
    4. Fox AA,
    5. Collard CD,
    6. Shernan SK,
    7. Body SC; CABG Genomics Investigators
    : Plasma neutrophil gelatinase-associated lipocalin and acute postoperative kidney injury in adult cardiac surgical patients. Anesth Analg 110: 1541–1547, 2010pmid:20435938
    OpenUrlCrossRefPubMed
  75. ↵
    1. Rahmanian PB,
    2. Filsoufi F,
    3. Castillo JG,
    4. Zaku B,
    5. Chikwe J,
    6. Carpentier A,
    7. Adams DH
    : Predicting postoperative renal failure requiring dialysis, and an analysis of long-term outcome in patients undergoing valve surgery. J Heart Valve Dis 17: 657–665, 2008pmid:19137798
    OpenUrlPubMed
    1. Ried M,
    2. Lunz D,
    3. Kobuch R,
    4. Rupprecht L,
    5. Keyser A,
    6. Hilker M,
    7. Schmid C,
    8. Diez C
    : Gender’s impact on outcome in coronary surgery with minimized extracorporeal circulation. Clin Res Cardiol 101: 437–444, 2012pmid:22228145
    OpenUrlCrossRefPubMed
  77. ↵
    1. Rioux JP,
    2. Lessard M,
    3. De Bortoli B,
    4. Roy P,
    5. Albert M,
    6. Verdant C,
    7. Madore F,
    8. Troyanov S
    : Pentastarch 10% (250 kDa/0.45) is an independent risk factor of acute kidney injury following cardiac surgery. Crit Care Med 37: 1293–1298, 2009pmid:19242349
    OpenUrlCrossRefPubMed
    1. Ryckwaert F,
    2. Boccara G,
    3. Frappier JM,
    4. Colson PH
    : Incidence, risk factors, and prognosis of a moderate increase in plasma creatinine early after cardiac surgery. Crit Care Med 30: 1495–1498, 2002pmid:12130968
    OpenUrlCrossRefPubMed
    1. Rydén L,
    2. Sartipy U,
    3. Evans M,
    4. Holzmann MJ
    : Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease. Circulation 130: 2005–2011, 2014pmid:25239439
    OpenUrlAbstract/FREE Full Text
  80. ↵
    1. van Straten AH,
    2. Hamad MA,
    3. van Zundert AA,
    4. Martens EJ,
    5. Schönberger JP,
    6. de Wolf AM
    : Risk factors for deterioration of renal function after coronary artery bypass grafting. Eur J Cardiothorac Surg 37: 106–111, 2010pmid:19699103
    OpenUrlCrossRefPubMed
    1. Vellinga S,
    2. Verbrugghe W,
    3. De Paep R,
    4. Verpooten GA,
    5. Janssen van Doorn K
    : Identification of modifiable risk factors for acute kidney injury after cardiac surgery. Neth J Med 70: 450–454, 2012pmid:23230014
    OpenUrlPubMed
    1. Vives M,
    2. Monedero P,
    3. Perez-Valdivieso JR,
    4. Garcia-Fernandez N,
    5. Lavilla J,
    6. Herreros J,
    7. Bes-Rastrollo M; Spanish Renal Dysfunction in Cardiac Surgery Group
    : External validation and comparison of three scores to predict renal replacement therapy after cardiac surgery: A multicenter cohort. Int J Artif Organs 34: 329–338, 2011pmid:21534243
    OpenUrlCrossRefPubMed
  83. ↵
    1. Wijeysundera DN,
    2. Karkouti K,
    3. Dupuis JY,
    4. Rao V,
    5. Chan CT,
    6. Granton JT,
    7. Beattie WS
    : Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA 297: 1801–1809, 2007pmid:17456822
    OpenUrlCrossRefPubMed
    1. Xu JR,
    2. Zhu JM,
    3. Jiang J,
    4. Ding XQ,
    5. Fang Y,
    6. Shen B,
    7. Liu ZH,
    8. Zou JZ,
    9. Liu L,
    10. Wang CS,
    11. Ronco C,
    12. Liu H,
    13. Teng J
    : Risk factors for long-term mortality and progressive chronic kidney disease associated with acute kidney injury after cardiac surgery. Medicine (Baltimore) 94: e2025, 2015pmid:26559305
    OpenUrlCrossRefPubMed
  85. ↵
    1. Zanardo G,
    2. Michielon P,
    3. Paccagnella A,
    4. Rosi P,
    5. Caló M,
    6. Salandin V,
    7. Da Ros A,
    8. Michieletto F,
    9. Simini G
    : Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 107: 1489–1495, 1994pmid:8196394
    OpenUrlPubMed
  86. ↵
    1. Zhang WF,
    2. Gu TX,
    3. Diao C,
    4. Zhang YH,
    5. Wang C,
    6. Fang Q,
    7. Wang HL
    : Comparison of transient changes in renal function between off-pump and on-pump coronary artery bypass grafting. Chin Med J (Engl) 121: 1537–1542, 2008pmid:18982864
    OpenUrlPubMed
    1. Machado MN,
    2. Nakazone MA,
    3. Maia LN
    : Prognostic value of acute kidney injury after cardiac surgery according to kidney disease: Improving global outcomes definition and staging (KDIGO) criteria. PLoS One 9: e98028, 2014pmid:24826910
    OpenUrlCrossRefPubMed
  88. ↵
    1. Mehta RH,
    2. Castelvecchio S,
    3. Ballotta A,
    4. Frigiola A,
    5. Bossone E,
    6. Ranucci M
    : Association of gender and lowest hematocrit on cardiopulmonary bypass with acute kidney injury and operative mortality in patients undergoing cardiac surgery. Ann Thorac Surg 96: 133–140, 2013pmid:23673070
    OpenUrlCrossRefPubMed
  89. ↵
    1. Shahian DM,
    2. O’Brien SM,
    3. Filardo G,
    4. Ferraris VA,
    5. Haan CK,
    6. Rich JB,
    7. Normand SL,
    8. DeLong ER,
    9. Shewan CM,
    10. Dokholyan RS,
    11. Peterson ED,
    12. Edwards FH,
    13. Anderson RP; Society of Thoracic Surgeons Quality Measurement Task Force
    : The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1--coronary artery bypass grafting surgery. Ann Thorac Surg 88[Suppl]: S2–S22, 2009pmid:19559822
    OpenUrlCrossRefPubMed
  90. ↵
    1. Antunes PE,
    2. de Oliveira JF,
    3. Antunes MJ
    : Risk-prediction for postoperative major morbidity in coronary surgery. Eur J Cardiothorac Surg 35: 760–766, 2009pmid:19243970
    OpenUrlCrossRefPubMed
    1. Hein OV,
    2. Birnbaum J,
    3. Wernecke KD,
    4. Konertz W,
    5. Jain U,
    6. Spies C
    : Three-year survival after four major post-cardiac operative complications. Crit Care Med 34: 2729–2737, 2006pmid:16971859
    OpenUrlCrossRefPubMed
  92. ↵
    1. Noyez L
    : Influence of the definition of acute renal failure post-cardiac surgery on incidence, patient identification, and identification of risk factors. Eur J Cardiothorac Surg 39: e8–e12, 2011pmid:21167730
    OpenUrlCrossRefPubMed
    1. Parolari A,
    2. Pesce LL,
    3. Pacini D,
    4. Mazzanti V,
    5. Salis S,
    6. Sciacovelli C,
    7. Rossi F,
    8. Alamanni F; Monzino Research Group on Cardiac Surgery Outcomes
    : Risk factors for perioperative acute kidney injury after adult cardiac surgery: Role of perioperative management. Ann Thorac Surg 93: 584–591, 2012pmid:22269725
    OpenUrlCrossRefPubMed
  94. ↵
    1. Stallwood MI,
    2. Grayson AD,
    3. Mills K,
    4. Scawn ND
    : Acute renal failure in coronary artery bypass surgery: Independent effect of cardiopulmonary bypass. Ann Thorac Surg 77: 968–972, 2004pmid:14992908
    OpenUrlCrossRefPubMed
  95. ↵
    1. Coca SG,
    2. Jammalamadaka D,
    3. Sint K,
    4. Thiessen Philbrook H,
    5. Shlipak MG,
    6. Zappitelli M,
    7. Devarajan P,
    8. Hashim S,
    9. Garg AX,
    10. Parikh CR; Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury Consortium
    : Preoperative proteinuria predicts acute kidney injury in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 143: 495–502, 2012pmid:22050987
    OpenUrlCrossRefPubMed
    1. Hong S,
    2. Youn YN,
    3. Yoo KJ
    : Metabolic syndrome as a risk factor for postoperative kidney injury after off-pump coronary artery bypass surgery. Circ J 74: 1121–1126, 2010pmid:20410619
    OpenUrlCrossRefPubMed
    1. Li SY,
    2. Chuang CL,
    3. Yang WC,
    4. Lin SJ
    : Proteinuria predicts postcardiotomy acute kidney injury in patients with preserved glomerular filtration rate. J Thorac Cardiovasc Surg 149: 894–899, 2015pmid:25433643
    OpenUrlCrossRefPubMed
    1. O’Brien SM,
    2. Shahian DM,
    3. Filardo G,
    4. Ferraris VA,
    5. Haan CK,
    6. Rich JB,
    7. Normand SL,
    8. DeLong ER,
    9. Shewan CM,
    10. Dokholyan RS,
    11. Peterson ED,
    12. Edwards FH,
    13. Anderson RP; Society of Thoracic Surgeons Quality Measurement Task Force
    : The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 2--isolated valve surgery. Ann Thorac Surg 88[Suppl]: S23–S42, 2009pmid:19559823
    OpenUrlCrossRefPubMed
    1. Shahian DM,
    2. O’Brien SM,
    3. Filardo G,
    4. Ferraris VA,
    5. Haan CK,
    6. Rich JB,
    7. Normand SL,
    8. DeLong ER,
    9. Shewan CM,
    10. Dokholyan RS,
    11. Peterson ED,
    12. Edwards FH,
    13. Anderson RP; Society of Thoracic Surgeons Quality Measurement Task Force
    : The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 3--valve plus coronary artery bypass grafting surgery. Ann Thorac Surg 88[Suppl]: S43–S62, 2009pmid:19559824
    OpenUrlCrossRefPubMed
  100. ↵
    Shroyer AL, Coombs LP, Peterson ED, Eiken MC, DeLong ER, Chen A, Ferguson TB Jr, Grover FL, Edwards FH; Society of Thoracic Surgeons: The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg 75: 1856–1864, 2003
    1. Simonini M,
    2. Lanzani C,
    3. Bignami E,
    4. Casamassima N,
    5. Frati E,
    6. Meroni R,
    7. Messaggio E,
    8. Alfieri O,
    9. Hamlyn J,
    10. Body SC,
    11. Collard CD,
    12. Zangrillo A,
    13. Manunta P; CABG Genomics Investigators
    : A new clinical multivariable model that predicts postoperative acute kidney injury: Impact of endogenous ouabain. Nephrol Dial Transplant 29: 1696–1701, 2014pmid:24920842
    OpenUrlCrossRefPubMed
  102. ↵
    1. Thakar CV,
    2. Liangos O,
    3. Yared JP,
    4. Nelson D,
    5. Piedmonte MR,
    6. Hariachar S,
    7. Paganini EP
    : ARF after open-heart surgery: Influence of gender and race. Am J Kidney Dis 41: 742–751, 2003pmid:12666060
    OpenUrlCrossRefPubMed
  103. ↵
    1. Xue JL,
    2. Daniels F,
    3. Star RA,
    4. Kimmel PL,
    5. Eggers PW,
    6. Molitoris BA,
    7. Himmelfarb J,
    8. Collins AJ
    : Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol 17: 1135–1142, 2006pmid:16495381
    OpenUrlAbstract/FREE Full Text
    1. Nash K,
    2. Hafeez A,
    3. Hou S
    : Hospital-acquired renal insufficiency. Am J Kidney Dis 39: 930–936, 2002pmid:11979336
    OpenUrlCrossRefPubMed
    1. Liangos O,
    2. Wald R,
    3. O’Bell JW,
    4. Price L,
    5. Pereira BJ,
    6. Jaber BL
    : Epidemiology and outcomes of acute renal failure in hospitalized patients: A national survey. Clin J Am Soc Nephrol 1: 43–51, 2006pmid:17699189
    OpenUrlAbstract/FREE Full Text
  106. ↵
    1. Hsu RK,
    2. McCulloch CE,
    3. Dudley RA,
    4. Lo LJ,
    5. Hsu CY
    : Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol 24: 37–42, 2013pmid:23222124
    OpenUrlAbstract/FREE Full Text
  107. ↵
    1. Karkouti K,
    2. Beattie WS,
    3. Wijeysundera DN,
    4. Rao V,
    5. Chan C,
    6. Dattilo KM,
    7. Djaiani G,
    8. Ivanov J,
    9. Karski J,
    10. David TE
    : Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 129: 391–400, 2005pmid:15678051
    OpenUrlCrossRefPubMed
  108. ↵
    1. DeFoe GR,
    2. Ross CS,
    3. Olmstead EM,
    4. Surgenor SD,
    5. Fillinger MP,
    6. Groom RC,
    7. Forest RJ,
    8. Pieroni JW,
    9. Warren CS,
    10. Bogosian ME,
    11. Krumholz CF,
    12. Clark C,
    13. Clough RA,
    14. Weldner PW,
    15. Lahey SJ,
    16. Leavitt BJ,
    17. Marrin CA,
    18. Charlesworth DC,
    19. Marshall P,
    20. O’Connor GT; Northern New England Cardiovascular Disease Study Group
    : Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Ann Thorac Surg 71: 769–776, 2001pmid:11269449
    OpenUrlCrossRefPubMed
  109. ↵
    1. Swaminathan M,
    2. Phillips-Bute BG,
    3. Conlon PJ,
    4. Smith PK,
    5. Newman MF,
    6. Stafford-Smith M
    : The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Ann Thorac Surg 76: 784–791, 2003pmid:12963200
    OpenUrlCrossRefPubMed
  110. ↵
    1. Murray PT,
    2. Thakar CV
    : Acute kidney injury and critical care. Nephrol Self Assess Program 14: 97–169, 2015
    OpenUrl
  111. ↵
    1. Mehta RH,
    2. Grab JD,
    3. O’Brien SM,
    4. Bridges CR,
    5. Gammie JS,
    6. Haan CK,
    7. Ferguson TB,
    8. Peterson ED; Society of Thoracic Surgeons National Cardiac Surgery Database Investigators
    : Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation 114: 2208–2216, 2006pmid:17088458
    OpenUrlAbstract/FREE Full Text
  112. ↵
    1. Englberger L,
    2. Suri RM,
    3. Li Z,
    4. Dearani JA,
    5. Park SJ,
    6. Sundt TM 3rd. ,
    7. Schaff HV
    : Validation of clinical scores predicting severe acute kidney injury after cardiac surgery. Am J Kidney Dis 56: 623–631, 2010pmid:20630639
    OpenUrlCrossRefPubMed
  113. ↵
    1. Wilson FP,
    2. Yang W,
    3. Machado CA,
    4. Mariani LH,
    5. Borovskiy Y,
    6. Berns JS,
    7. Feldman HI
    : Dialysis versus nondialysis in patients with AKI: A propensity-matched cohort study. Clin J Am Soc Nephrol 9: 673–681, 2014pmid:24651073
    OpenUrlAbstract/FREE Full Text
  114. ↵
    1. Edwards FH,
    2. Carey JS,
    3. Grover FL,
    4. Bero JW,
    5. Hartz RS
    : Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 66: 125–131, 1998pmid:9692451
    OpenUrlCrossRefPubMed
  115. ↵
    1. Hogue CW Jr..,
    2. Barzilai B,
    3. Pieper KS,
    4. Coombs LP,
    5. DeLong ER,
    6. Kouchoukos NT,
    7. Dávila-Román VG
    : Sex differences in neurological outcomes and mortality after cardiac surgery: A society of thoracic surgery national database report. Circulation 103: 2133–2137, 2001pmid:11331252
    OpenUrlAbstract/FREE Full Text
    1. Koch CG,
    2. Weng YS,
    3. Zhou SX,
    4. Savino JS,
    5. Mathew JP,
    6. Hsu PH,
    7. Saidman LJ,
    8. Mangano DT; Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group
    : Prevalence of risk factors, and not gender per se, determines short- and long-term survival after coronary artery bypass surgery. J Cardiothorac Vasc Anesth 17: 585–593, 2003pmid:14579211
    OpenUrlCrossRefPubMed
  117. ↵
    1. Mitter N,
    2. Shah A,
    3. Yuh D,
    4. Dodd-O J,
    5. Thompson RE,
    6. Cameron D,
    7. Hogue CW
    : Renal injury is associated with operative mortality after cardiac surgery for women and men. J Thorac Cardiovasc Surg 140: 1367–1373, 2010pmid:20381074
    OpenUrlCrossRefPubMed
  118. ↵
    1. Karkouti K
    : Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth 109[Suppl 1]: i29–i38, 2012pmid:23242748
    OpenUrlCrossRefPubMed
  119. ↵
    1. Macedo E,
    2. Bouchard J,
    3. Soroko SH,
    4. Chertow GM,
    5. Himmelfarb J,
    6. Ikizler TA,
    7. Paganini EP,
    8. Mehta RL; Program to Improve Care in Acute Renal Disease Study
    : Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care 14: R82, 2010pmid:20459609
    OpenUrlCrossRefPubMed
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Sex and the Risk of AKI Following Cardio-thoracic Surgery: A Meta-Analysis
Joel Neugarten, Sandipani Sandilya, Beenu Singh, Ladan Golestaneh
CJASN Dec 2016, 11 (12) 2113-2122; DOI: 10.2215/CJN.03340316
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