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Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery

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Abstract

Purpose

To investigate the association between preoperative low serum albumin level and acute kidney injury (AKI) after off-pump coronary artery bypass surgery (OPCAB)

Method

We assessed preoperative and perioperative risk factors, and preoperative serum albumin concentration in 1,182 consecutive adult patients with preoperative normal renal function who underwent OPCAB surgery. Each patient was categorized by maximal Acute Kidney Injury Network (AKIN) criteria based on creatinine changes within the first 48 h after OPCAB. Logistic regression and propensity analyses were performed to evaluate the association between preoperative low serum albumin level and postoperative AKI.

Results

Of the 1,182 patients, 334 (28.3%) developed AKI. Risk factors for AKI were old age, diabetes mellitus, maximal cardiovascular component of the sequential organ failure assessment score, perioperative transfusion, and postoperative C-reactive protein concentration. The risk of AKI was negatively correlated with the volume of crystalloid infused during surgery. A preoperative serum albumin level of <4.0 g/dl was independently associated Ith postoperative AKI [multivariable logistic analysis: odds ratio (OR) 1.83, 95 % confidence interval (CI) 1.27–2.64; P = 0.001; propensity analysis: OR 1.62, 95 % CI 1.12–2.35; P = 0.011). AKI was associated with prolonged stay in the intensive care unit and hospital and a high mortality rate.

Conclusions

Preoperative low serum albumin level is an independent risk factor for AKI, and postoperative AKI is associated with poor outcomes after OPCAB in patients with preoperative normal renal function.

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Acknowledgments

We would like to thank Ji-Yeon Kim, M.D. in Department of Anesthesiology and Pain Medicine of Asan Medical Center (Seoul, Korea) for valuable contributions to data collection.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong, Songpa-gu, Seoul, 138-736, Korea

    Eun-Ho Lee, Ji-Hyun Chin, Dae-Kee Choi, Hyo-Jung Son, Wook-Jong Kim, Kyung-Don Hahm, Ji-Yeon Sim & In-Cheol Choi

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Seung-Hee Baek

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  1. Eun-Ho Lee
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Correspondence to In-Cheol Choi.

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Lee, EH., Baek, SH., Chin, JH. et al. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med 38, 1478–1486 (2012). https://doi.org/10.1007/s00134-012-2599-8

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