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Wang, C., Gao, Y., Tian, Y., Wang, Y., Zhao, W., Sessler, D. I., Jia, Y., Ji, B., Diao, X., Xu, X., Wang, J., Li, J., Wang, S., Liu, J. Prediction of acute kidney injury after cardiac surgery from preoperative N-terminal pro-B-type natriuretic peptide. Br J Anaesth 2021: 127 (6) 862-870

October 16, 2021

Background: Acute kidney injury (AKI) is common after cardiac surgery and is difficult to predict. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is highly predictive for perioperative cardiovascular complications and may also predict renal injury. We therefore tested the hypothesis that preoperative NT-proBNP concentration is associated with renal injury after major cardiac surgery.

Methods: We included 35 337 patients who had cardiac surgery and measurements of preoperative NT-proBNP and postoperative creatinine. The primary outcome was Kidney Disease: Improving Global Outcomes Stages 1e3 AKI. We also separately considered severe AKI, including Stage 2, Stage 3, and new-onset dialysis.

Results: Postoperative AKI occurred in 11 999 (34.0%) patients. Stage 2 AKI occurred in 1200 (3.4%) patients, Stage 3 AKI in 474 (1.3%) patients, and new-onset dialysis was required in 241 (0.7%) patients. The NT-proBNP concentrations (considered continuously or in quartiles) were significantly correlated with any-stage AKI and severe AKI (all adjusted P<0.01). Including NT-proBNP significantly improved AKI prediction (net reclassification improvement: 0.24 [0.220.27]; P<0.001) beyond basic models derived from other baseline factors in the overall population. Reclassification was especially improved for higher grades of renal injury: 0.30 (0.250.36) for Stage 2, 0.46 (0.370.55) for Stage 3, and 0.47
(0.350.60) for dialysis.

Conclusions: Increased preoperative NT-proBNP concentrations were associated with postoperative AKI in patients having cardiac surgery. Including NT-proBNP substantially improves AKI predictions based on other preoperative factors.

Keywords: acute kidney injury; anaesthesia; cardiac surgery; dialysis; N-terminal pro-B-type natriuretic peptide; risk assessment