Postoperative Acute Kidney Injury in Cardiovascular Surgery Patients with Prolonged Intensive Care Unit Stay: Impact on Mortality and Outcomes.

Authors

Bedih Balkan, Engin Ihsan Turan, Ahmet Said Dündar, Lokman Yalçın

Published in

Brazilian journal of cardiovascular surgery. Volume 41. Issue 3. Pages e20250271. Sep 21, 2026. Epub Sep 21, 2026.

Abstract

To evaluate the association between postoperative acute kidney injury (AKI) and outcomes in adults undergoing cardiovascular surgery who required a prolonged intensive care unit (ICU) stay.
We conducted a retrospective cohort study of consecutive cardiovascular surgery patients with ICU stay ≥ 72 hours. AKI was defined and staged using creatinine-based Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcome was in-hospital mortality. Secondary outcomes were time to extubation, ICU days until ward transfer, and perioperative transfusion exposure (red blood cells/fresh frozen plasma/platelet/apheresis); initiation of renal replacement therapy was assessed exploratorily. Multivariable logistic regression examined the association between AKI and mortality, adjusting for age, sex, baseline renal function/chronic kidney disease (estimated glomerular filtration rate category), hypertension, diabetes, chronic obstructive pulmonary disease, ejection fraction (or Age Creatinine Ejection Fraction score), procedure type (coronary artery bypass grafting/valve/combined), cardiopulmonary bypass and cross-clamping times, transfusions, and post-cardiopulmonary bypass vasoactive/inotropic use where available.
AKI was frequent after cardiovascular surgery and was independently associated with higher in-hospital mortality in adjusted analyses. Patients with AKI also had longer time to extubation, greater transfusion requirements, and prolonged ICU stay, with a stepwise worsening across KDIGO stages. Findings were consistent in sensitivity analyses. Incomplete urine-output data were acknowledged as a limitation, as oliguria forms part of KDIGO definitions.
Among cardiovascular surgery patients with prolonged ICU stay, postoperative AKI is a strong predictor of in-hospital mortality and adverse resource-related outcomes. Emphasis on prevention, early detection, and optimized perioperative management may improve prognosis in this high-risk population.

PMID:
42776136
Bibliographic data and abstract were imported from PubMed on 23 Sep 2026.

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