November 11, 2016

A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery

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The authors of this study developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery.  They identified 8 independent predictors of acute kidney injury requiring renal replacement therapy in the derivation model(adjusted odds ratio, 95% confidence interval [CI]): congestive heart failure (3.03, 2.00-4.58), Canadian Cardiovascular Society angina class III or higher (1.66, 1.15-2.40), diabetes mellitus (1.61, 1.12-2.31), baseline estimated glomerular filtration rate (0.96, 0.95-0.97), increasing hemoglobin concentration (0.85, 0.77-0.93), proteinuria (1.65, 1.07-2.54), coronary artery bypass graft (CABG) plus valve surgery (v. CABG only, 1.25, 0.64-2.43), other cardiac procedure (v. CABG only, 3.11, 2.12-4.58) and emergent status for surgery booking (4.63, 2.61-8.21). The 8-variable risk prediction model was found to have excellent performance characteristics in the validation cohort (C statistic 0.83, 95% CI 0.79-0.86). Furthermore, the net reclassification improvement with the prediction model was 13.9% (p < 0.001) compared with the best existing risk prediction model (Cleveland Clinic Score).

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Acute Kidney Injury, Clinical Nephrology, Hemodialysis