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ASN / Education & Meetings / Kidney Week /
Abstract: TH-PO071

Intraoperative Microvascular Perfusion in Cardiac Surgery-Associated AKI: A Prospective Longitudinal Cohort

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Joslin, Jennifer R., King's College London, London, United Kingdom
  • Satchell, Simon C., University of Bristol, Bristol, United Kingdom
  • Sharpe, Claire C., King's College Hospital, London, London, United Kingdom
  • Bramham, Kate, King's College London, London, United Kingdom
Background

We have previously presented the association between intraoperative endothelial glycocalyx (EGx) degradation (quantified by plasma syndecan-1 (SDC1)) and cardiac surgery-associated acute kidney injury (CSA-AKI). This novel study aimed to explore the relationship between intraoperative microvascular perfusion and CSA-AKI.

Methods

Twenty patients selected from a prospective observational cohort study of 61 patients undergoing coronary artery bypass graft (CABG) surgery were included. Sublingual microvascular perfused vessel density (PVD) was assessed by incident dark field videomicroscopy at three time-points: preoperatively, intraoperatively after haemostasis, and immediately postoperatively. CSA-AKI within 48 hours was assessed (KDIGO criteria). Demographic, clinical and surgical variables were evaluated.

Results

3/20 (15%) participants developed CSA-AKI.
Intraoperative PVD was significantly lower in those who did develop CSA-AKI than in those who did not (Figure 1). There were no significant differences in preoperative or postoperative results between groups.
There was a moderate negative correlation between intraoperative PVD and SDC1 levels measured at the same time point: R = -0.54, p = 0.015.
Intraoperative PVD was the best predictor of CSA-AKI with an area under the curve of 0.92 (95% confidence interval 0.79 – 1.00).

Conclusion

This is the first demonstration of impaired intraoperative microvascular perfusion in CABG patients who later developed CSA-AKI, and highlights the association between EGx health and microvascular perfusion. These findings offer potential targets for early therapeutic intervention and / or earlier identification of patients at greatest risk of CSA-AKI.

Intraoperative PVD in patients with and without CSA-AKI