Cardiac or heart surgery
- Patients who undergo cardiac or heart surgery experience postoperative renal function
deterioration mainly associated with acute renal injury.
- Commonly held notion that women are at greater risk for acute kidney injury after cardiovascular surgery is now disputed.
- Though previous studies have mentioned
that women are at more risk of acute renal failure, the association is not
linked with parameters which indicate kidney function deterioration.
is one of the treatment options
for heart disease such as coronary artery blockage or valve replacement.
However this surgery can have side effects including acute kidney injury
(AKI) or renal damage. Studies have shown that postoperative
kidney function deterioration in cardiac surgery patients increases in-hospital
mortality and can adversely affects long-term survival.
Studies have previously shown that
women are more likely than men to develop kidney damage following cardiac
surgery. Interestingly it was also believed that women are less likely to develop AKI associated with
non-cardiac surgical procedures than men.
‘Acute kidney injury is the decline in kidney function which can arise following major cardiac surgery because the kidneys are deprived of normal blood flow.’
current study examined in greater detail the evidence as to why being a woman
might be protective for ischemic AKI after general surgery but deleterious in
patients undergoing heart surgery.
What is Acute Kidney Injury (AKI)?
AKI, an abrupt decline
in kidney function can arise following any major surgery, often because the
kidneys are deprived of normal blood flow during the procedure. It is characterized by a deterioration of
kidney function over a period of hours or days following surgery, with symptoms
including reduced urine output (less than 400ml/day) or oliguria. Decrease
urine output usually results in volume overload, elevated levels of serum blood
urea nitrogen and creatinine, and the development of serious electrolyte and
that Contradicts the Popular Belief that being a
Woman is a Risk factor for the development of Acute Kidney Injury after Cardiac
Joel Neugarten, MD, Albert Einstein College
of Medicine and his colleagues performed a systematic review and meta-analysis
of relevant studies published between January 1978 and December 2015 to find
out if women are at a higher risk after cardiac surgery. The analysis included
64 studies with 1,057,412 participants.
The understanding of the pathophysiology of AKI is
both clinically and experimentally complicated as AKI develops under different
clinical scenarios. Few vital risk factors to consider are -
chronic kidney disease,
- Type and
duration of cardiac surgery.
The link between the risk was true as far as
gender-specific data was considered but was not seen in studies in which
certain stringent classification methods called Risk, Injury, Failure, Loss, End-Stage (RIFLE) and Acute
Kidney Injury Network (AKIN) criteria were used to define and AKI based
on serum creatinine and urine output. When the investigators focused solely on
studies that took patient characteristics and other factors into account there
was also no association between sex and AKI risk.
have disputed the commonly held notion that women are at greater risk for acute
kidney injury after cardiovascular surgery," said Dr. Neugarten.
Aggressive early intervention by identifying
individuals at risk for developing AKI is important to optimize outcomes.
- Acute Kidney Injury after Cardiovascular Surgery:
An Overview - (http://cjasn.asnjournals.org/content/early/2016/10/19/CJN.03340316.abstract)
- Sex and the Risk of AKI Following Cardio-thoracic
Surgery: A Meta-Analysis - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487575/)