Predictors of acute kidney injury after coronary artery bypass grafting in patients with non-ST-segment elevation acute coronary syndrome

Aim: To identify predictors of acute kidney injury (AKI) after coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Material and methods. The study included patients with NSTE-ACS and multivessel coronary artery disease, for whom the cardiac team determined indications for CABG. Initially, during the first 7 days after CABG and prior to discharge from the hospital, creatinine levels in the blood were measured using the Jaffe method (Synchron CX Systems, USA), and the initial levels of N-terminal pro-brain natriuretic peptide (Nt-proBNP) were examined using an immunochemical method (Elecsys, Roche). Chronic kidney disease (CKD) was diagnosed if the glomerular filtration rate (GFR) was less than 60 ml/min/1,73 m². GFR was calculated using the CKD-EPI formula. CABG was performed either on a "beating heart" or under conditions of artificial circulation. AKI was diagnosed according to KDIGO criteria (2012). In-hospital complications of CABG including AKI, intraoperative myocardial infarction (MI), bleeding, multiple organ failure and cardiac deathwere recorded. The cumulative incidence rate of in-hospital complications, including thoselisted, was calculated, taking into account the first occurrence of the event.

Results. We examined 70 patients with NSTE-ACS, 32,9% of whom had MI. The mean age was 65 years, and 77,1% of the patients were men. They had multivessel coronary artery disease. All patients had arterial hypertension, 31,4% had type 2 diabetes mellitus, and 17,1% had CKD. The initial Nt-proBNP level was 168 (54-902) pg/ml. After CABG, AKI developed in 15 (21,4%) patients, with stage 1 AKI occurring in 17,1%, and stage 2 and 3 in 4,1%. Parameters associated with the development of postoperative AKI included a higher incidence of stages 3 and 4 CKD (p=0,05), an initial left ventricular ejection fraction < 50% (p=0,031), intraoperative MI (p=0,036), the use of adrenaline to stabilize hemodynamics (p=0,001), and a higher initial Nt-proBNP level (909, 278-1394 pg/ml, p=0,011). Nt-proBNP was found to be a predictor of AKI after CABG. A level above the median value of 900 (278-1394) pg/ml increased the likelihood of AKI development by an average factor of 9,0 times. Patients with AKI after CABG showed a tendency toward a higher cumulative incidence of in-hospital complications compared to those without AKI (40% and 16,4%, respectively, p=0,05).

Conclusion. The incidence of AKI after CABG in patients with NSTE-ACS was 24,1%. On average, the likelihood of developing AKI after CABG was 9,0 times higher for patients with an initial Nt-proBNP level above the median value (900, 278-1394 pg/ml). Patients who developed AKI after CABG were more likely to experience adverse in-hospital complications than those without postoperative AKI.

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