CARDIAC SURGERY ASSOCIATED ACUTE KIDNEY INJURY: EXPERIENCE AT A TERTIATARY CARE HOSPITAL IN BANGLADESH

 

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https://storage.unitedwebnetwork.com/files/1099/fe7c18044275696892a15d56e2f57381.pdf
CARDIAC SURGERY ASSOCIATED ACUTE KIDNEY INJURY: EXPERIENCE AT A TERTIATARY CARE HOSPITAL IN BANGLADESH

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Mohammad Mehfuz
E Khoda
Mohammad Mehfuz E Khoda mehfuzek@yahoo.com BIRDEM General Hospital Department of Nephrology Dhaka Bangladesh *
Nazia Nusrat Khan nazianusratkhan@yahoo.com Ibrahim Cardiac Hospital & Research Institute Department of Anesthesiology & Intensive care unit Dhaka Bangladesh -
Muhammad Abdur Rahim muradrahim23@yahoo.com BIRDEM General Hospital Department of Nephrology Dhaka Bangladesh -
Rafi Nazrul Islam dr.rafinislam@gmail.com BIRDEM General Hospital Department of Nephrology Dhaka Bangladesh -
Ishrat Jahan Shimu jahanishrat76@gmail.com National Institute of Cardiovascular Disease Department of Cardiology Dhaka Bangladesh -
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Cardiac surgery associated acute kidney injury (CSA-AKI) occurs from a rapid deterioration in renal function following cardiac surgery, expressed as a significant decrease in glomerular filtration rate (GFR). The reported prevalence of CSA-AKI is up to 30% and the majority of the patients lead to long term morbidity and mortality. The pathogenesis of CSA-AKI is multifaceted, involve reduced renal blood flow, dislodged emboli obstruct renal arteries and detrimental effects from cardiopulmonary bypass (CPB) (ischemia, hemolysis, inflammation, oxidative stress). In addition, medications used during and after surgery can contribute to kidney injury. Current diagnostic methods for CSA-AKI have limitations, hindering early intervention and individualized patient management can give better outcome. This study was conducted to find out the incidence of CSA-AKI with risk factors to develop AKI and their outcome. 

This hospital-based observational study was conducted at post-surgical intensive care unit of Ibrahim Cardiac Hospital and Research Institute (ICHRI), Dhaka, Bangladesh from January 2024 to July 2025. Total 62 patients were included in this study who underwent cardiac surgery.  AKI was defined according to KDIGO 2012 guidelines. Data was analyzed by SPPS 24 version.

Total patients were 62 included in the study with mean age 56.32 ±10.23 years and male predominant (male 43, 69.4%). Types of cardiac surgery were coronary artery bypass graft (CABG) and mitral valve replacement (MVR) operation (CABG 87.1%, MVR 9.7% and both 3.2%). Hypertension (51, 82.3%) and diabetes mellitus (38, 61.3%) were the major co-morbidities among the patient. Among 62 patients, 21 (33.9 %) developed CSA-AKI. Hypotension (30, 48.4%), sepsis (22, 35.5%) and arrhythmia (17, 27.4%) were the major factors associated with development of CSA-AKI. Most of the patients who developed AKI were improved after conservation treatment and four required renal replacement therapy. Among AKI patient, four died due to prolonged hypotension and sepsis. 

One third of patients developed CSA-AKI and hypotension, sepsis and arrhythmias were the major factors associated with developed CSA-AKI. So, preventive measures, early detection and proper management help to reverse the adverse outcome. 

Kewords