Predicting Kidney Injury Following Valvular Heart Surgery in An Elderly Cohort: The Missing Links

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 37; no. 2; pp. 277 - 278
• Main Author: Magoon, Rohan
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Cirurgia Cardiovascular 2022
• Subjects: Acute Kidney Injury - etiology; Aged; Cardiac Surgical Procedures - adverse effects; Female; Glucose; Heart; Heart surgery; Heart Valve Diseases - surgery; Hemodynamics; Humans; Kidney; Kidneys; Letter to the Editor; Male
• ISSN: 1678-9741; 0102-7638; 1678-9741
• DOI: 10.21470/1678-9741-2021-0075

Despite a prospective consecutive evaluation of a large homogenous cohort (elderly patients undergoing valvular heart surgery) in the index study, certain points require authors’ comments and clarification to enhance the lucidity of their findings. a. While preoperative diabetes mellitus did not emerge as a baseline risk-predictor of CS-AKI (19.7% and 15.6% incidence in AKI and non-AKI population, respectively), the lack of elucidation of perioperative glucose homeostasis in the present study captivates attention, particularly when poor glucose control has been linked to an enhanced propensity for CS-AKI owing to an augmented oxidative stress, endothelial dysfunction and systemic inflammatory response2-4. [...]the authors also fail to delineate their institutional perioperative glucose management protocol. b. Talking of the hemodynamic predisposition to CS-AKI, there are additional caveats that merit elaboration. Ahead of the fact that estimated CVP at 6 h postoperatively has been found to be significantly associated with CS-AKI in the non-congested cardiac surgical subset6, possible links should definitely not be overlooked in valvular heart disease patients included in the present study who can be particularly prone to postoperative systemic venous congestion7. c. Lastly, the lack of comparative account for inotropes-vasopressors in the AKI and non-AKI groups or a standardized inotrope-vasopressor study protocol requires consideration while interpreting the findings. Congestive kidney failure in cardiac surgery: the relationship between central venous pressure and acute kidney injury.