Faculty Collaboration Database

Renal Angina Is a Sensitive, but Nonspecific Identifier of Postcardiac Surgery Acute Kidney Injury. J Cardiothorac Vasc Anesth 2019 Feb;33(2):357-364

Date

09/24/2018

Pubmed ID

30243866

DOI

10.1053/j.jvca.2018.07.017

Scopus ID

2-s2.0-85053693098 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

OBJECTIVES: Acute kidney injury (AKI) is a common complication of cardiac surgery, and early detection is difficult. This study was performed to determine the sensitivity, specificity, positive predictive value, negative predictive value, and statistical performance of renal angina (RA) as an early predictor of AKI in an adult cardiac surgical patient population.

DESIGN: Retrospective, nonrandomized, observational study.

SETTING: A single, university-affiliated, quaternary medical center.

PARTICIPANTS: The study comprised 324 consecutive patients undergoing coronary artery bypass grafting or cardiac valvular surgery from February 1 through July 30, 2014.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: One hundred-seven patients at moderate or high risk of developing postoperative renal injury were identified, 82 of whom met criteria for RA. The occurrence of RA was found to have an 80.9% sensitivity and 30.8% specificity for the prediction of AKI using Acute Kidney Injury Network criteria and 89.3% sensitivity and 27.8% specificity when paired with the Risk, Injury, Failure, Loss, End Stage Renal Disease criteria. A receiver operating characteristic area under the curve analysis revealed a nonsignificant predictive ability of 55.8% (95% confidence interval 0.47-0.65) when RA was paired with Acute Kidney Injury Network criteria; however, the receiver operating characteristic area under the curve was significant when paired with Risk, Injury, Failure, Loss, End Stage Renal Disease criteria, with a predictive ability of 0.586 (0.509-0.662).

CONCLUSIONS: RA is a sensitive, but nonspecific, predictor of postcardiac surgery AKI, with clinical utility most suited as a screening tool.

Author List

Fierro MA, Ehieli EI, Cooter M, Traylor A, Stafford-Smith M, Swaminathan M, Duke Critical Care Outcomes Research Endeavors (C-CORE) Group

Author

Michael Fierro MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Aged
Biomarkers
Cardiac Surgical Procedures
Creatinine
Early Diagnosis
Female
Follow-Up Studies
Glomerular Filtration Rate
Humans
Incidence
Male
Middle Aged
North Carolina
Postoperative Complications
Predictive Value of Tests
ROC Curve
Retrospective Studies