| Effect of preoperative serum uric acid on the risk of the acute kidney injury after cardiac surgery |
| Received:January 22, 2019 Revised:March 18, 2019 Click here to download the full text |
| Citation of this paper:徐夏莲，许佳瑞，王一梅，耿雪梅，陈 欣，章晓燕，罗 哲，王春生，滕 杰，丁小强.Effect of preoperative serum uric acid on the risk of the acute kidney injury after cardiac surgery[J].Chinese Journal of Clinical Medicine,2019,26(3):450-455 |
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| Abstract:Objective：To investigate the effect of preoperative serum uric acid on the risk of acute kidney injury (AKI) in the patients undergoing cardiac surgery. Methods：Clinical data of the patients underwent cardiac surgery in Zhongshan Hospital of Fudan University from June 1st, 2016 to December 31th, 2016 were collected, including age, sex, height, weight, comorbidity, blood and urine routine, kidney function, electrolytes, blood glucose tests, etc. AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Hyperuricemia is defined as serum uric acid > 360 μmol/L (female) and > 420 μmol/L (men and postmenopausal women). Logistic regression analysis was applied to analyze the risk factors for postoperative AKI. Results：A total of 1 722 patients were included, among whom, 527 patients were diagnosed with hyperuricemia (30.6%). The overall AKI incidence was 35.5% (n=611). The percentage of AKI patients with hyperuricemia was significantly higher than those with normal serum uric acid (43.6% vs 31.9%, P＜0.001 ), and the rate of critical AKI was significantly higher (10.1% vs 6.3%, P=0.006) than those with normal serum uric acid. The duration of ICU in patients with hyperuricemia was significantly longer than that in patients with normal uric acid (P＜ 0.001). The hospitalization cost of the hyperuricemia group was also significantly higher than that of the normal uric acid group. There was no statistical difference in renal replacement treatment (RRT), hospitalization time, AKI mortality, and overall mortality between the two groups. In subgroup analysis, hyperuricemia patients with eGFR ≥60 mL/(min·1.73 m2) represented a significantly higher rate of AKI than those with normal uric acid (40.8% vs 31.5%, P=0.001). There was no statistical difference between two groups in the eGFR <60 mL/(min·1.73 m2) group. Multivariate regression analysis showed that independent risk factors for AKI after cardiac surgery included male, age (for every additional year), hypertension, diabetes, NYHA>Ⅱ, preoperative eGFR<60 mL/(min·1.73 m2), hyperuricemia, aortic aneurysm surgery, and intraoperative extracorporeal circulation time (for every additional hour). Conclusions：The incidence of AKI in patients with hyperuricemia might increase significantly after surgery. Hyperuricemia might be regarded as an independent risk factor of AKI following cardiac surgery. |
| keywords:serum uric acid acute kidney injury cardiac surgery hyperuricemia |
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