European Journal of Cardiovascular Medicine

Background- Acute kidney injury (AKI) is common after cardiac surgery. To date, there are no specific pharmacological therapies. In this review, we summarise the existing evidence for prevention and management of cardiac surgery-associated AKI and outline areas for future research. Preoperatively, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be withheld and nephrotoxins should be avoided to reduce the risk. Methods- The present study is an observational study was conducted at tertiary care center on all the patients undergoing on pump CABG during the study period of 18 months i.e. from 1st January 2020 to 30th June 2021. Adult patients belonging to 41 to 70 years of age, of Either gender, Diagnosed with triple vessel, double vessel or even single vessel disease, Scheduled for on-pump CABG surgery and Belonging to the American Society of Anaesthesiologist (ASA) –II and III physical status were included.  Results- The average age of patients undergoing cardiac surgeries in India is 60 years. ] In present study, majority of patients undergoing on-pump CABG belonged to elderly age group (>60years) and more than 75% cases were males. CABG can be done as both off pump and on pump procedure. On pump CABG is the procedure of choice in presence of CPB. Literature sugeste CPB is an important factor associated with AKI. Chloride liberal fluids were used in our study in patients while undergoing on pump CABP. Both ringer lactate and normal saline were the chloride liberal fluids used in almost all the cases (>95%) irrespective of presence or absence of AKI. PRBC and cryoprecipitate were required in majority of patients whereas FFP and SDP were required in only few cases. In present study, we documented no significant association of AKI with the blood products used (p>0.05). Mean systolic blood pressure preoperatively was 127.53±10.32 whereas that postoperatively was 113.47 ± 9.75 mmHg. Similarly, mean diastolic blood pressure before and after the procedure was 72.53±12.53 mmHg and 58.97 ±7.52 mmHg respectively. We documented no significant difference in mean SBP as well as DBP in patients with or without AKI (p>0.05). Conclusions- Based on this study, peri-operative AKI is high in pump CABG patients receiving chloride liberal fluids like normal saline and/or ringer lactate. Chloride liberal fluids in on-pump CABG predict AKI, but age, gender, comorbidities, amount of fluids, duration of CPB & CABG, transfusion of blood & blood products, and systolic & diastolic blood pressure did not. Our study participants had higher AKI rates, but this did not affect adverse outcomes or mortality.