Cardiothoracic & vascular anesthesia
Perioperative Bleeding Is Not an Independent Risk Factor for Acute Kidney Injury in On-pump Cardiac Surgery—A Post-hoc Analysis of a Randomized Clinical Trial
Authors' conclusion
In on-pump cardiac surgery, perioperative bleeding was not an independent risk factor for AKI but manifested as AKI via hypotension and higher fluid balance.
Study context
- Population
- On-pump cardiac surgical patients in a trial of 4% albumin vs Ringer's acetate for CPB priming and perioperative volume replacement
- Participants
- 1,386 patients
- Comparison
- Perioperative bleeding and acute kidney injury (AKI)
- Primary endpoint
- AKI (KDIGO creatinine criteria) in association with bleeding (UDPB classification)
Methodological detailspost-hoc, single-centre, logistic regression, mediation analysis
- Post-hoc
- Single-centre
- Logistic regression
- Mediation analysis
Primary result
As reported in the abstract
Association of bleeding with AKI
- AKI incidence
- 139 (10%)
- Model 1: Universal Definition of Perioperative Bleeding (UDPB) class "severe" bleeding, OR
- 2.16 (1.19-3.89) (95% CI)
- Model 1: "massive" bleeding, OR
- 6.78 (1.8-25.33) (95% CI)
- Model 1: AKI Risk Score, OR
- 1.51 (1.29-1.78) (95% CI)
- Model 3 (mediation): combined "severe" and "massive" bleeding, no direct effect, regression coefficient
- 0.32 (−0.26 to 0.91) (95% CI)
- Model 3: MAP indirect effect on AKI
- 0.08 (0.003-0.21)
- Model 3: fluid balance indirect effect on AKI
- 0.12 (0.17-0.27)
Further findings
Model 2 (UDPB components)
- AKI Risk Score, OR
- 1.55 (1.33-1.82) (95% CI)
- FFP transfusion, OR
- 1.29 (1.06-1.58) (95% CI)
Original publication
Perioperative Bleeding Is Not an Independent Risk Factor for Acute Kidney Injury in On-pump Cardiac Surgery—A Post-hoc Analysis of a Randomized Clinical Trial. J Cardiothorac Vasc Anesth. Published 6 March 2025. doi:10.
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