ABSTRACTS from 16th International COnference on ... - CRRT Online

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<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT, SAN DIEGO, FEB 14-17, 2012 Early nephrology consultation could result in better outcomes, but daily presence of the nephrology resident in the postoperative cardiac intensive care unit (PC-ICU) and its relationship with hard outcomes has not been explored. Purpose: We assessed the incidence of AKI, renal recovery, ICU length of stay, and in-hospital mortality following cardiac surgery before and after the daily presence of the nephrology resident as part of the PC-ICU team. Methods: We conducted a retrospective cohort study of 2 consecutive periods of time in adults taken to cardiac surgery in a single-center: <strong>from</strong> March 2009 to February 2010 (nephrology consultation by call) and <strong>from</strong> March 2010 to February 2011 (daily presence). We excluded patients with chronic kidney disease stage V, AKI or renal replacement therapy (RRT) before surgery. AKI was defined according to AKIN and RIFLE classifications within 7 days since cardiac surgery. We used multivariable linear and logistic regression to adjust for confounding variables. Results: We included 1096 patients who were taken to cardiac surgery in the Instituto Nacional de Cardiología Ignacio Chávez in Mexico City, 558 in the consultation period and 538 in the daily-nephrology-presence period. AKI occurred in 31.9% of patients in the consultation group and 28.7% in the daily group (p=0.019); inhospital mortality was 8.25% and 5.6% (p=0.082). Adjusting for age, baseline renal function, risk scores (Euroscore and Thakar score), infections, and length of mechanical ventilation, the daily presence of the nephrology resident was associated with a lower risk of AKI (OR 0.714 [95% CI 0.520-0.982], p=0.039), shorter ICU length of stay (Beta -0.095 [95% CI 0.000 to -0.146], p=0.044) and lower in-hospital mortality (OR 0.469 [95% CI 0.256-0.858], p=0.014). In those patients who required RRT the daily nephrology presence was associated with a lower risk of failure to recover renal function (OR 0.023 [95% CI 0.001-0.384], p=0.009). Conclusion: Daily presence of the nephrology resident in PC-ICU was associated with lower risk of AKI, inhospital mortality and seems to promote renal recovery in patients requiring RRT. The present model of attention is a proposal with potential benefits in teaching hospitals. Daily nephrology presence B S.E Wald df Sig - 0.757 Exp (B) 95% IC 0.308 6.029 1 0.014 0.469 0.256- 0.858 Re-intervention 0.266 0.337 0.622 1 0.430 1.305 0.674- 2.527 Bleeding (mL) 0.000 0.00 0.113 1 0.736 1.000 1.000- 1.000 Heart failure 0.436 0.369 1.394 1 0.238 1.546 0.750- 3.188 Length of mechanical(days) 0.029 0.019 2.225 1 0.136 1.029 0.991- 1.069 ventilation CPB (min) 0.009 0.003 9.768 1 0.002 1.009 1.003- 1.015 CKD-EPI (mL/min/m2) - 0.016 0.006 8.444 1 0.004 0.984 0.973- 0.995 Severe infection 1.379 0.360 14.637 1 0.000 3.969 1.959- 8.043 Euroscore 0.202 0.047 18.641 1 0.000 1.223 1.116- 1.340 AKIN 1 0.429 0.345 1.549 1 0.213 1.536 0.781- 3.019 AKIN 2 1.590 0.519 9.387 1 0.002 4.905 1.774- 13.567 AKIN 3 1.450 0.665 4.760 1 0.029 4.265 1.159- 15.694 163
<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT, SAN DIEGO, FEB 14-17, 2012 53. A New Clinical Score to Predict Acute Kidney Injury After Cardiac Surgery in Chinese Elderly Patients Penghua Hu, Xinling Liang, Yuanhan Chen, Ruizhao Li, Zhilian Li, Fen Jiang, Wei Shi Division of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong,510080,China Objective: To develop and validate a risk score to predict acute kidney injury (AKI) after cardiac surgery in Chinese elderly patients. Methods: A consecutive sample of 848 elderly patients(age≥60 years old) who underwent cardiac surgery with cardiopulmonary bypass in the Guangdong general hospital between January 1, 2005 and July 31, 2010 was evaluated. The clinical outcome was AKI according to the serum creatinine criteria of the RIFLE classification during the first 7 days postoperatively. Patients were excluded if they had an end stage renal disease, or experienced renal replacement therapy. Those who had missing data were also excluded. In randomly selected 682 patients of the total cohorts, multivariate logistic regression analysis was used to develop a new prediction score based on clinical characteristics and perioperative variables of patients. The new score was validated on the remaining patients. Result: The incidence of AKI in the derivation cohort which consisted of 682 patients was 62.3% (n=425), while in the test cohort which consisted of 166 patients was 59.6% (n=99). Eight variables were included in the predictive index. Those variables in the new score that an estimated glomerular filtration rate less than 60 ml/min, male , hypertension, chronic heart failure New York Heart Association above stage 2, perioperative red blood cell transfusions above 625 ml were assigned 2 points, respectively. Cardiopulmonary bypass time above 113 minutes and duration of ventilator-assisted respiration during postoperative above 24 hours were assigned 3 points, respectively; other component was assigned 1 point: previous cardiac surgery. The patients with risk score≤4 in derivation, the risk of AKI was 26.0%; comparatively, the risk was 92.6% among patients with risk score≥13. The area under the receiver operating characteristic curve, judging the discrimination of the score, was 0.798 (95%CI 0.764 to 0.832) in the derivation, which in the validation set was 0.804 (95%CI 0.739 to 0.870). The calibration of the score assessed using the Hosmer-Lemeshow statistic in the derivation and validation were 0.478, 0.224, respectively. Conclusion: A new score based on Chinese information was valid and accurate in predicting AKI after cardiac surgery in elderly patients. This score may allow prevention of post-operative AKI and early institution of therapeutic interventions to attenuate the impact of AKI on the prognosis of cardiac surgery patients. 54. The Impact of Acute Kidney Injury on In-Hospital Morbidity and Mortality Among Patients With and Without Baseline Chronic Kidney Disease Mira T Keddis, Sahil Khanna, Qi Qian Mayo Clinic, Rochester, MN, USA Background: Acute kidney injury (AKI) is a well-recognized risk for chronic kidney disease (CKD) and in-hospital mortality. The effect of AKI on inhospital morbidity and mortality among 164
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CRRT 2012 SEVENTEENTH INTERNATIONAL
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FACULTY DISCLOSURES CRRT 2012 Facul
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CRRT 2012 ORGANIZING COMMITTEE USA
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CRRT 2012 FACULTY Patrick Honoré,
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ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
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PLENARY SESSIONS CRRT 2012 PROGRAM/
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WORKSHOPS CRRT 2012 PROGRAM/INDEX T
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WORKSHOPS CRRT 2012 PROGRAM/INDEX W
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POSTER ABSTRACTS C
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POSTER ABSTRACTS C
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NURSING FORUM LUNCHEON Communicatio
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Nutritional Support in ICU Patients
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Educational Objectives: The Endothe
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SPECIAL LECTURE Engineering Critica
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Nishimura R, Ornato JP, Page RL, Ri
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Do Vasoactive Drugs and Fluids Impr
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Blood Transfusions are Important fo
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Thinking Outside of the Box: A Nove
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Nursing Forum 2 Luncheon Benchmarki
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4. Mori K, Lee HT, Rapoport D, Drex
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Differential Diagnosis of AKI: Can
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Myocardial Stunning and Brain Edema
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4. Udy A, Roberts JA, Lipman J. Wha
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CRRT and ECMO: Techniques and Outco
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Management of Severe Heart Failure:
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Avoiding Anticoagulation for CRRT:
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Improving Outcomes from</st
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The Changing Face of AKI: Snapshots
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Alkaline Phosphatase Peter Pickkers
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creatinine (Cr) was measured using
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Surveillance and Early Recognition
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therapy admitted to general intensi
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A01 Assessing the Microcirculation
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A01 Assessing the Microcirculation
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C03 Critical Care Pharmacology: Vas
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D04 Biomarkers 1: Principles and Ap
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6. Ferguson JW, Dover AR, Chia S, C
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G07 Fluids and Solutions in the Cri
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A09 Vascular Access /Membrane and C
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A09 Vascular Access /Membrane and C
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C11 Critical Care Management: Nutri
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D12 Biomarkers 2: Application in AK
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Educational Objectives: E13 Liver a
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G15 Fluids and Solutions in the Cri
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Educational Objectives: 1) Discuss
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B18 Fluid Management Ravindra L. Me
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C19 Acid Base and Electrolyte Probl
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D20 Extracorporeal Techniques for S
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the mediatordelivery hypothesis. In
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F22 Ensuring Patient Safety and Qua
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H24 Patient Centered Care in the IC
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B26 Starting and Stopping RRT for A
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C27 Acid Base and Electrolyte Probl
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D28 Extracorporeal Techniques for S
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