What is the optimal time interval between heart catheterization and surgery to prevent acute kidney injury in patients with isolated coronary artery bypass?

Aim
The aim of the article was to study the role of the time between cardiac catheterization and cardiac surgery in the development of early postoperative acute kidney injury in patients who underwent isolated coronary artery bypass grafting was investigated.

Material and methods
A total of 1196 patients (832 males, 364 females; mean age 60.8 ±8.2 years; range: 32–74 years) operated between November 2006 and June 2014 at the same centre and by the same team for isolated coronary artery bypass grafting with cardiopulmonary bypass, whose preoperative serum creatinine level was < 1.5 mg/dl, were enrolled in the study. Patients were divided into group 1 – with acute kidney injury in the early postoperative period (n = 207) and group 2 – without (n = 989). Univariate analyses were done to determine significant clinical factors, and subsequent multiple logistic regression analysis was performed to determine independent predictors of acute kidney injury.

Results
A total of 207 (17.3%) patients developed acute kidney injury during 72 h postoperatively. Regarding the time interval between coronary angiography and coronary artery bypass grafting, there was a statistically highly significant difference between the patients with and without acute kidney injury (7.8 and 11.9 days, respectively; p = 0.0001). Postoperative C-reactive protein (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis revealed the time between cardiac catheterization and surgery (p = 0.0001), increased postoperative C-reactive protein (p = 0.007 and p = 0.0001, respectively), and erythrocyte sedimentation rate (p = 0.0001) as independent predictors of early postoperative acute kidney injury in patients undergone isolated coronary artery bypass grafting.

Conclusions
If patients to be operated on are stable from a cardiac aspect, limitation of surgery in the early period following catheterization results in reduction of the incidence of postoperative acute kidney injury.