Predicción de lesión renal aguda asociada a cirugía cardíacala escala crate

Resumen

Introducción La injuria o lesión renal aguda (LRA) es una complicación frecuente en el post-operatorio de cirugía cardíaca y se asocia a un incremento de la morbimortalidad. El diagnostico precoz es fundamental en el abordaje de esta entidad para iniciar tempranamente medidas preventivas. El objetivo de este estudio fue diseñar una escala de predicción postoperatoria de LRA no dialítica, en pacientes con función renal previa normal operados de cirugía cardiaca con circulación extracorpórea. Material y métodos Se diseñó una recogida de datos de forma prospectiva en 909 pacientes intervenidos de cirugía cardíaca con circulación extracorpórea entre los años 2011 y 2013. De todos ellos, un total de 810 pacientes cumplieron los criterios de inclusión. Los pacientes fueron clasificados de acuerdo a la aparición de LRA siguiendo los criterios RIFLE (acrónimo de Risk, Injury, Failure, Loss, End-stage; riesgo, daño, fallo, pérdida, terminal). Utilizamos como nivel de creatinina basal la obtenida en el análisis de laboratorio al ingreso del paciente en el hospital. Recogimos diversos parámetros pre e intraoperatorios, y al ingreso del paciente en la unidad de cuidados intensivos, buscando una asociación con el riesgo de desarrollar LRA. Las variables que se asociaron de forma significativa con el riesgo de LRA fueron testadas para precisión mediante el análisis de curvas COR (característica operativa del receptor). Las variables con mejor área bajo la curva fueron analizadas en un modelo de regresión logística multivariante por pasos hacia delante. Resultados Un total de 137 pacientes (16,9%) presentaron LRA en el postoperatorio. Tras realizar el análisis estadístico incluimos cuatro factores de riesgo independiente en la escala CRATE: creatinina (odds ratio [OR] 9,66; 95% intervalo de confianza [IC] 4,77-19,56; p < 0.001), ácido láctico (OR 1,03; IC 1,01-1,04; p < 0,001), tiempo de circulación extracorpórea (OR 1,01; IC 1,01-1,02; p < 0,001), y EuroSCORE (OR 1,40; IC 1,29-1,52; p < 0,001). La escala de riesgo de lesión renal fue realizada en 24 base al peso de cada variable significativa. La precisión del modelo fue moderadamente buena, con un área bajo la curva de 0,89; IC 0,85-0,92. Calculamos la probabilidad de padecer lesión renal según diferentes rangos de riesgo, lo que resultó en la obtención de cinco categorías de riesgo: muy bajo (2%), bajo (8,5%), moderado (33.8%), alto (57,5%), y muy alto (84,7%). Además realizamos un análisis de supervivencia en función de la aparición de lesión renal asociada a cirugía cardíaca que demostró que existen diferencias significativas entre ambos grupos. Los pacientes que desarrollaron lesión renal aguda en nuestra población tienen menor supervivencia tanto a los 30, como a los 90 días. Conclusiones CRATE (acrónimo de Creatinina, Ácido láctico, Tiempo de circulación extracorpórea, y Euroscore) es una escala de riesgo precisa y fácil de calcular que emplea variables fáciles de obtener en cualquier centro donde se lleven a cabo procedimientos quirúrgicos cardíacos rutinariamente. BIBLIOGRAFÍA 1. Weisse AB. Medical odysseys: the different and unexpected pathways to twentieth century medical discoveries. New Brunswick (NJ): Rutgers University Press. 1991;229. 2. Hufnagel CA, Harvey WP. The surgical correction of aortic regurgitation preliminary report. Bull Georgetown Univ Med Cent. 1953;6:60-61. 3. Weisse AB. The surgical treatment of mitral stenosis: the first heart operation. Am J Cardiol. 2009;103:143-147. 4. Starr A, Edwards ML. Mitral replacement: clinical experience with a ballvalve prosthesis. Ann Surg. 1961;154:726-40. 5. Harken DE, Soroff HS, Taylor WJ, Lefemine AA, Gupta SK, Lunzer S. Partial and complete prostheses in aortic insufficiency. J Thorac Cardiovasc Surg. 1960;40:744-762. 6. Carpentier A, Lemaigre G, Robert L, Carpentier S, Dubost C. Biological factors affecting long-term results of valvular heterografts. J Thorac Cardiovasc Surg. 1969; 58:467-483. 7. Konstantinov IE. Goetz: the surgeon who performed the first successful clinical coronary artery bypass operation. Ann Thorac Surg. 2000;69:1966- 1972. 8. Weisse AB. Heart to heart: the twentieth century battle against cardiac disease. An oral history. New Brunswick (NJ): Rutgers University Press. 2002:203- 220. 9. Favaloro RG. Critical analysis of coronary artery bypass graft surgery: a 30- year journey. J Am Coll Cardiol. 1998;31:1B-63B. 10. Gibbon JH Jr. The development of the heart-lung apparatus. Am J Surg. 1978;135:608-619. 11. Dewall RA, Gott VL, Lillehei CW, Read RC, Varco RL, Warden HE, Ziegler NR. A simple, expendable, artificial oxygenator for open heart surgery. Surg Clin North Am. 1956:1025-1034. 12. DeBakey M. The development of vascular surgery. Am J Surg. 1979;137:697- 738. 13. Livesay JJ, Messner GN, Vaughn WK. Milestones in the treatment of aortic aneurysm: Denton A. Cooley, MD, and the Texas Heart Institute. Tex Heart Inst J. 2005;32:130-134. 14. Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA. 1945;138:189. 15. Potts WJ, Smith S, Gibson S. Anastomosis of the aorta to a pulmonary artery: certain types in congenital heart disease. JAMA. 1946;132:627-631. 16. Sellors TH. Surgery of pulmonary stenosis: a case in which the pulmonary valve was successfully divided. Lancet, 1948;1:988. 17. Blalock A. Physiopathology and surgical treatment of congenital cardiovascular defects: Harvey Lecture, November 15, 1945. Bull N Y Acad Med. 1946;41:90-116. 18. Brock RC. The surgery of pulmonic stenosis. Br Med J. 1949;2:399-406. 19. Litwak RS. The growth of cardiac surgery: historical notes. Cardiovasc Clin, 1971;3:5-50. 20. Harmel MH, Lamont A. Anesthesia in the surgical treatment of congenital pulmonic stenosis. Anesthesiology. 1946;7:477-498. 21. Rink EH, Helliwel PJ, Hutton AM, Anaesthesia for operations for the relief of congenital pulmonary stenosis. Guys Hosp Rep. 1948;97:48. 22. Harris AJ. The management of anesthesia for congenital heart operations in children. Anesthesiology. 1950;11:328. 23. McQuiston WO. Anesthetic problems in cardiac surgery in children. Anesthesiology. 1949;10:590-600. 24. McQuiston WO. Anesthesia in cardiac surgery: observations on three hundred and sixtytwo cases. Arch Surg. 1950;61:892-902. 25. Conn AW, Allan D, Junkin CI. Anaesthesia with hypothermia for closure of atrial septal defects in children. Can Anaesth Soc J. 1959;6:327-336. 26. Wasmuth CE. Anesthesia for mitral commissurotomy. Cleve Clin Q. 1953;20:346-352. 27. Patrick RT, Theye RA, Moffitt EA. Studies in extracorporeal circulation: V. Anesthesia and supportive care during intracardiac surgery with the Gibbontype pumpoxygenator. Anesthesiology. 1957;18:673-685. 28. Lowenstein E, Hallowell P, Levine FH, Daggett WM, Austen WG, Laver MB. Cardiovascular response to large doses of intravenous morphine in man. N Engl J Med, 1969;281:1389-1393. 29. Wynands JE, Sheridian C, Kelkar K. Coronary artery disease and anaesthesia: experience in 120 patients for revascularization of the heart. Can Anaesth Soc J. 1967;14:382-398. 30. Miller R. Miller¿s Anesthesia Textbook. 6th edition. Elsevier, 2005. 31. Stammers A. Extracorporeal devices and related technologies. Kaplan, Reich, Konstadt, editores. Cardiac anesthesia. Philadelphia. Saunders Company:1017-1060. 32. De Somer F, François K, van Oeveren W, Poelaert J, De Wolf D, Ebels T, Van Nooten G. Phosphorylcholine coating of extracorporeal circuits provides natural protection against blood activation by the material surface. Eur J Cardiothorac Surg. 2000;18:602-606. 33. Nutter BT, Stammers AH, Schmer RG, Ahlgren RL, Ellis TA, Gao C, Holcomb HB, Hock L, Burkeman T. The rheological effects of X-Coating with albumin and hetastarch on blood during cardiopulmonary bypass. J Extra Corpor Technol. 2004;36:36-43. 34. Schreurs HH, Wijers MJ, Gu YJ, van Oeveren W, van Domburg RT, de Boer JH, Bogers AJ. Heparin-coated bypass circuits: Effects on inflammatory response in pediatric cardiac operations. Ann Thorac Surg. 1998;66:166-171. 35. Ask A, Holt D, Smith L. In vivo comparison study of FDA-approved surfacemodifying additives and poly-2-methoxyethylacrylate circuit surfaces coatings during cardiopulmonary bypass. J Extra Corpor Technol. 2006;38:27-32. 36. Linneweber J, Chow TW, Kawamura M, Moake JL, Nosè Y. In vitro comparison of blood pump induced platelet microaggregates between a centrifugal and roller pump during cardiopulmonary bypass. Int J Artif Organs. 2002;25:549-555. 37. Nishinaka T, Nishida H, Endo M, Miyagishima M, Ohtsuka G, Koyanagi H. Less blood damage in the impeller centrifugal pump: A comparative study with the roller pump in open heart surgery. Artif Organs. 1996;20:707-710. 38. Federspiel W, Henchir K. Basic principles and current applications. In Wnek GE, Bowlin GL (eds): Encyclopedia of Biomaterials and Biomedical Engineering. New York, Marcel Dekker. 2004:910-921. 39. Oriaku G, Xiang B, Dai G, Shen J, Lindsay WG, Deslauriers R, Tian G. Effects of retrograde cardioplegia on myocardial perfusion and energy metabolism in immature porcine myocardium. Thorac Cardiovasc Surg. 2000;119:1102-1109. 40. Wan S, LeClerc J, Vincent JL. Inflammatory response to cardiopulmonary bypass: Mechanisms involved and possible therapeutic strategies. Chest, 1997;112:676-692. 41. Nieman G, Searles B, Carney D, McCann U, Schiller H, Lutz C, Finck C, Gatto LA, Hodell M, Picone A. Systemic inflammation induced by cardiopulmonary bypass: A review of pathogenesis and treatment. J Extra Corpor Technol. 1999;31:202-210. 42. Goudeau JJ, Clermont G, Guillery O, Lemaire-Ewing S, Musat A, Vernet M, Vergely C, Guiguet M, Rochette L, Girard C. In high- risk patients, combination of antiinflammatory pro- cedures during cardiopulmonary bypass can reduce incidences of inflammation and oxidative stress. J Cardiovasc Pharmacol. 2007;49:39-45. 43. Rubens FD, Mesana T. The inflammatory response to cardiopulmonary bypass: A therapeutic overview. Perfusion. 2004;19:S5-S12. 44. Eltzschig HK, Rosenberg P, Löffler M, Fox JA, Aranki SF, Shernan SK. Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery. Ann Thorac Surg. 2008;85:845-852. 45. Shernan SK. Perioperative myocardial ischemia reperfusion injury. Anesthesiol Clin North America. 2003;21:465-485. 46. Suleiman MS, Zacharowski K, Angelini GD. Inflammatory response and cardioprotection during open-heart surgery: the importance of anaesthetics. Br J Pharmacol. 2008;153:21-33. 47. Russo AM, O'Connor WH, Waxman HL. Atypical presentations and echocardiographic findings in patients with cardiac tamponade occurring early and late after cardiac surgery. Chest. 1993;104:71-78. 48. Shoaib RF, Anwar F, Nyawo B, Sarkar P. Bilateral tension pneumothoraces following coronary artery bypass grafting. J Coll Physicians Surg Pak. 2009;19:444-446. 49. Stevenson LW. Clinical use of inotropic therapy for heart failure: looking backward or forward? Part I: inotropic infusions during hospitalization. Circulation. 2003;108:367-372. 50. Sanders D, Dudley M, Groban L. Diastolic dysfunction, cardiovascular aging, and the anesthesiologist. Anesthesiol Clin. 2009;27:497-517. 51. Weissman C. Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004;8:185-211. 52. Nilsson J, Hansson E, Andersson B. Intestinal ischemia after cardiac surgery: analysis of a large registry. J Cardiothorac Surg. 2013;18:156. 53. Ohri SK, Velissaris T. Gastrointestinal dysfunction following cardiac surgery. Perfusion. 2006;21:215-223. 54. Clavien PA, Muller C, Harder F. Treatment of mesenteric infarction. Br J Surg. 1987;74:500-503. 55. Oliveira DC, Oliveira Filho JB, Silva RF, Moura SS, Silva DJ, Egito ES, Martins SK, Souza LC, Jatene AD, Piegas LS. Sepsis in the postoperative period of cardiac surgery: problem description. Arq Bras Cardiol. 2010;94:352-356. 56. Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Moi BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA. 2006;296:2460-2466. 57. Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, Saha SP, Hessel EA 2nd, Haan CK, Royston BD, Bridges CR, Higgins RS, Despotis G, Brown JR; Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Spiess BD, Shore-Lesserson L, Stafford-Smith M, Mazer CD, Bennett-Guerrero E, Hill SE, Body S. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg. 2007;83:S27- S86. 58. Hajjar L, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, Fukushima J, Kalil Filho R, Sierra DB, Lopes NH, Mauad T, Roquim AC, Sundin MR, Leao WC, Almeida JP, Pomerantzeff PM, Dallan LO, Jatene FB, Stolf NA, Auler JO Jr. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010;304:1559-1567. 59. Hébert P, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. New Engl J Med. 1999;340:409-417. 60. Dacey L, Munoz JJ, Baribeau YR, Johnson ER, Lahey SJ, Leavitt BJ, Quinn RD, Nugent WC, Birkmeyer JD, O¿Connor GT. Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England Cardiovascular Disease Study Group. Arch Surg. 1998;133:442- 447. 61. Matthai WJ Jr. Thrombocytopenia in cardiovascular patients: diagnosis and management. Chest. 2005;127:46S-52S. 62. Eknoyan G. Emergence of the concept of acute renal failure. Am J Nephrol. 2002;22:225-230. 63. Dunn JS, McNee. A contribution to the study of war nephritis. Br Med J. 1917;2:118-120. 64. Bywaters EG, Beali D. Crush injuries with impairment of renal function. Br Med J. 1947;1:427-432. 65. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. JAMA. 1998;104:343-348. 66. de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F. Acute renal failure in the ICU: risk factors and outcome evaluated by SOFA score. Intensive Care Med. 2000;26:915-921. 67. Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;30:2051-2058. 68. Consentino F, Chaff C, Piedmonte M. Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant. 1994;9:179-182. 69. Erley C, Bader BD, Berger ED, Vochazer A, Jorzik JJ, Dietz K, Risler T. Plasma clearance of iodine contrast media as a measure of glomerular filtration rate in critically ill patients. Crit Care Med. 2001;29:1544-1550. 70. Doolan PD, Alpen E, Theil GB. A clinical appraisal of the plasma concentration and endogenous clearance of creatinine. Am J Med. 1962;32: p. 65-72. 71. Kim KE, Onesti G, Ramirez O, Brest AN, Swartz C. Creatinine clearance in renal disease. A reappraisal. BMJ. 1969;14:11-14. 72. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P and Acute Dialysis Quality Initiative workgroup. Acute renal failure ¿ definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical Care. 2004;8:204-212. 73. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis. 2002;39:S76-S92. 74. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31. 75. Englberger L, Suri RM, Li Z, Casey ET, Daly RC, Dearani JA, Schaff HV. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care. 2011;15:R16. 76. Kaufman J, Dhakal M, Patel B, Hamburger R. Community-acquired acute renal failure. Am J Kidney Dis. 1991;17:191-198. 77. Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983;74:243-248. 78. Bidani A, Churchill P. Hemodynamically mediated acute renal failure. N Engl J Med.1986;314:1515-1516. 79. Corwin HL, Teplick RS, Schreiber MJ, Fang LS, Bonventre JV, Coggins CH. Prediction of outcome in acute renal failure. Am J Nephrol. 1987;7:8-12. 80. Cameron JS. Acute renal failure ¿ the continuing challenge. Q J Med. 1986;59:337-343. 81. Davidman M, Olson P, Kohen J, Leither T, Kjelistrand C. Iatrogenic renal disease. Arch Intern Med. 1991;151:1809-1812. 82. Moore, RD, Smith CR, Lipsky JJ, Mellits ED, Lietman PS. Risk factors for nephrotoxicity in patients treated with aminoglycosides. Ann Intern Med, 1984;100:352-357. 83. Shankel SW, Johnson DC, Clark PS, Shankel TL, O¿Neil WM Jr. Acute renal failure and glomerulopathy caused by nonsteroidal anti-inflammatory drugs. Arch Intern Med. 1992;152:986-990. 84. Pascual J, Liaño F, Ortuno J. The elderly patient with acute renal failure. J Am Soc Nephrol. 1995;6:144-153. 85. Bridoux F, Hazzan M, Pallot JL, Fleury D, Lemaitre V, Kleinknecht D, Vanhille. Acute renal failure after the use of angiotensin-converting-enzyme inhibitors in patients without renal artery stenosis. Nephrol Dial Transplant. 1992;7:100-104. 86. Hricik DE, Browning PJ, Kopelman R, Goorno WE, Madias NE, Dzau VJ. Captopril-induced functional renal insufficiency in patients with bilateral renal-artery stenoses or renal-artery stenosis in a solitary kidney. N Engl J Med. 1983;308:373-376. 87. Abuelo JG. Diagnosing vascular causes of renal failure. Ann Intern Med. 1995;123:601-614. 88. Kahan BD. Cyclosporine. N Engl J Med. 1989;321:1725-1738. 89. Textor SC, Wiesner R, Wilson DJ, Porayko M, Romero JC, Burnett JC Jr, Gores G, Hay E, Dickson ER, Krom RA. Systemic and renal hemodynamic differences between FK506 and cyclosporine in liver transplant recipients. Transplantation. 1993;55:1332-1339. 90. Shusterman N, Strom BL, Morrison G, West SL, Maislin G. Risk factors and outcome of hospital-acquired acute renal failure: clinical epidemiologic study. Am J Med. 1987;83:65-71. 91. Norman RW, Mack FG, Awad SA, Belitsky P, Schwarz RD, Lannon SG. Acute renal failure secondary to bilateral ureteric obstruction: review of 50 cases. Can Med Assoc J. 1982;127:601-604. 92. Feest TG, Round A, Hamad S. Incidence of severe acute renal failure in adults: results of a community based study. BMJ. 1993;306:481-483. 93. Richet G, Mignon F, Morel-Maroger L, Siguier F, Godeau P, Delluc G, Leibovitch M. Ro¿le de l¿obstruction uratique massive des lumie¿res tubulaires survenue au cours du traitement d¿une hemopathie maligne lors d¿une insuffisance re¿nale aiguë. Ann Med Interne (Paris). 1969;120:657-660. 94. Esnault V, Delcroix C, Dubigeon P, Guenel J. Insuffisance re¿nale aiguë re¿versible avec oxalose tubulaire: ro¿le possible de facteurs nutritionnels. Nephrologie. 1988;9:277-280. 95. Sawyer MH, Webb DE, Balow JE, Straus SE. Acyclovir-induced renal failure: clinical course and histology. Am J Med. 1988;84:1067-1071. 96. Carbone LG, Bendixen B, Appel GB. Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome. Am J Kidney. 1988;12:72-75. 97. Pitman S, Frei E 3rd. Weekly methotrexate-calcium leucovorin rescue: effect of alkalinization on nephrotoxicity; pharmacokinetics in the CNS; and use in CNS non-Hodgkin¿s lymphoma. Cancer Treat Rep. 1977;61:695-701. 98. Shapiro SR, Bennett AH. Recovery of renal function after prolonged unilateral ureteral obstruction. J Urol. 1976;115:136-140. 99. Paul AB, Love C, Chisholm GD. The management of bilateral ureteric obstruction and renal failure in advanced prostate cancer. Br J Urol. 1994;74:642-645. 100. Chugh KS, Jha V, Sakhuja V, Joshi K. Acute renal cortical necrosis ¿ a study of 113 patients. Ren Fail. 1994;16:37-47. 101. Better OS, Stein JH. Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med. 1990;322:835-829. 102. Meyer KB, Madias NE. Cisplatin nephrotoxicity. Miner Electrolyte Metab. 1994;20:201-213. 103. Kyle RA. Monoclonal proteins and renal disease. Annu Rev Med. 1994;45:71- 77. 104. Harris KP, Hattersley JM, Feehally J, Walls J. Acute renal failure associated with haematological malignancies: a review of 10 years experience. Eur J Haematol. 1991;47:119-122. 105. Rao TK, Friedman EA. Outcome of severe acute renal failure in patients with acquired immunodeficiency syndrome. Am J Kidney Dis. 1995;25:390-398. 106. Cooper K, Bennett WM. Nephrotoxicity of common drugs used in clinical practice. Arch Intern Med. 1987;147:1213-1218. 107. Cameron JS. Allergic interstitial nephritis: clinical features and pathogenesis. Q J Med. 1988;66:97-115. 108. Galpin JE, Shinaberger JH, Stanley TM, Blumenkratz MJ, Bayer AS, Friedman GS, Montgomerie JZ, Guze LB, Coburn JW, Glassock RJ. Acute interstitial nephritis due to methicillin. Am J Med. 1978;65:756-765. 109. Jennette JC, Falk RJ. The diagnosis and management of glomerulonephritis and vasculitis presenting as acute renal failure. Med Clin North Am. 1990;74:893-908. 110. Mason P, Pusey C. Glomerulonephritis: diagnosis and treatment. BMJ. 1995;310:1557-1563. 111. Thadhani R, Pascual M, Bonventre J. Acute renal failure. N Engl J Med. 1996;334:1440-1460. 112. Monedero P, García-Fernández N, Pérez-Valdivieso JR, Vives M, Lavilla J. Insuficiencia renal aguda. Rev Esp Anestesiol Reanim. 2011;58:365-374. 113. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C. Beginning, Ending Supportive Therapy for the Kidney I: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813-818. 114. Bellomo R, Auriemma S, Fabbri A, D¿Onofrio A, Katz N, McCullough PA, Ricci Z, Shaw A, Ronco C. The pathophysiology of cardiac surgery-associated acute kidney injury (CSA-AKI). Int J Artif Organs. 2008;31:166-178. 115. Zakeri R, Freemantle N, Barnett V, Lipkin GW, Bonser RS, Graham TR, Rooney SJ, Wilson IC, Cramb R, Keogh BE, Pagano D. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation. 2005;112:I270-I275. 116. Kumar AB, Suneja M, Bayman EO, Weide GD, Tarasi M. Association between postoperative acute kidney injury and duration of cardiopulmonary bypass: a meta-analysis. J Cardiothorac Vasc Anesth. 2012;26:64-69. 117. Stafford-Smith M, Shaw A, Swaminathan M. Cardiac surgery and acute kidney injury: emerging concepts. Curr Opin Crit Care. 2009;15:498-502. 118. Noyez L. Influence of the definition of acute renal failure post-cardiac surgery on incidence, patient identification, and identification of risk factors. Eur J Cardiothorac Surg. 2011;39:e8-e12. 119. Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, Dupuis JY, Fremes SE, Kent B, Laflamme C, Lamy A, Legare JF, Mazer CD, McCluskey SA, Rubens FD, Sawchuk C, Beattie WS. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009;119:495-502. 120. Bagur R, Webb JG, Nietlispach F, Dumont E, De Larochellière R, Doyle D, Masson JB, Gutiérrez MJ, Clavel MA, Bertrand OF, Pibarot P, Rodés-Cabau J. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparision with surgical aortic valve replacement. Eur Heart J. 2010;31:865-874. 121. D'Onofrio A, Cruz D, Bolgan I, Auriemma S, Cresce GD, Fabbri A, Ronco C. RIFLE criteria for cardiac surgery-associated acute kidney injury: risk factors and outcomes. Congest Heart Fail. 2010;16:S32-S36. 122. Swaminathan M, Hudson CC, Phillips-Bute BG, Patel UD, Mathew JP, Newman MF, Milano CA, Shaw AD, Stafford-Smith M. Impact of early renal recovery on survival after cardiac surgery-associated acute kidney injury. Ann Thorac Surg. 2010;89:1098-1104. 123. Robert AM, Kramer RS, Dacey LJ, Charlesworth DC, Leavitt BJ, Helm RE, Hernandez F, Sardella GL, Frumiento C, Likosky DS, Brown JR; Northern New England Cardiovascular Disease Study Group. Cardiac surgeryassociated acute kidney injury: a comparision of two consensus criteria. Ann Thorac Surg. 2010;90:1939-1943. 124. Brown JR, Kramer RS, Coca SG, Parikh C. Duration of acute kidney injury impacts long-term survival after cardiac surgery. Ann Thorac Surg. 2010;90:1142-1148. 125. Li SY, Chen JY, Yang WC, Chuang CL. Acute kidney injury network classification predicts in-hospital and long-term mortality in patients undergoing elective coronary artery bypass grafting surgery. Eur J Cardiothorac Surg. 2011;39:323-328. 126. Parolari A, Pesce LL, Pacini D, Mazzanti V, Salis S, Sciacovelli C, Rossi F, Alamanni F; Monzino Research Group on Cardiac Surgery Outcomes. Risk factors for perioperative acute kidney injury after adult cardiac surgery: role of perioperative management. Ann Thorac Surg. 2012;93:584-591. 127. Englberger L, Suri RM, Connolly HM, Li Z, Abel MD, Greason KL, Dearani JA, Schaff HV. Increased risk of acute kidney injury in patients undergoing tricuspid valve surgery. Eur J Cardiothorac Surg. 2013;43:993-999. 128. Swaminathan M, Shaw AD, Phillips-Bute BG, McGugan-Clark PL, Archer LE, Talbert S, Milano CA, Patel UD, Stafford-Smith M. Trends in acute renal failure associated with coronary artery bypass graft surgery in the United States. Crit Care Med. 2007;35:2286-2291. 129. Grayson AD, Khater M, Jackson M, Fox MA. Valvular heart operation is an independent risk factor for acute renal failure. Ann Thorac Surg. 2003;75:1829-1835. 130. Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15:1597-1605. 131. Kolli H, Rajagopalam S, Patel N, Ranjan R, Venuto R, Lohr J, Arora P. Mild acute kidney injury is associated with increased mortality after cardiac surgery in patients with EGFR <60 ml/min/1.73 m(2). Ren Fail. 2010;32:1066-1072. 132. Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005;365:1231-1238. 133. McIlroy D, Wagener G, Lee H. Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance. Clin J Am Soc Nephrol. 2010;5:211-219. 134. Parikh C. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2006;70:199-203. 135. Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, Dent C, Devarajan P, Edelstein CL. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol. 2011;22:1748-1757. 136. Rosner MH, Okusa M. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 2006;1:19-32. 137. Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16:162-168. 138. Mehta RH, Grab JD, O'Brien SM, Bridges CR, Gammie JS, Haan CK, Ferguson TB, Peterson ED; Society of Thoracic Surgeons National Cardiac Surgery Database Investigators. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation. 2006;114:2208-2216. 139. Wijeysundera DN, Karkouti K, Dupuis JY, Rao V, Chan CT, Granton JT, Beattie WS. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA. 2007;297:1801-1809. 140. Heise D, Sundermann D, Braeuer A, Quintel M. Validation of a clinical score to determine the risk of acute renal failure after cardiac surgery. Eur J Cardiothorac Surg. 2010;37:710-716. 141. Candela-Toha A, Elías-Martín E, Abraira V, Tenorio MT, Parise D, de Pablo A, Centella T, Liaño F. Predicting acute renal failure after cardiac surgery: External validation of two new clinical scores. Clin J Am Soc Nephrol. 2008;3:1260-1265. 142. Englberger L, Suri RM, Li Z, Dearani JA, Park SJ, Sundt TM 3rd, Schaff HV. Validation of clinical scores predicting severe acute kidney injury after cardiac surgery. Am J Kidney Dis. 2010;56:623-631. 143. Brown JR, Cochran RP, Leavitt BJ, Dacey LJ, Ross CS, MacKenzie TA, Kunzelman KS, Kramer RS, Hernandez F Jr, Helm RE, Westbrook BM, Dunton RF, Malenka DJ, O'Connor GT; Northern New England Cardiovascular Disease Study Group. Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery. Circulation. 2006;116:I139- I143. 144. Aronson S, Fontes ML, Miao Y, Mangano DT; Investigators of the Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. Risk Index for Perioperative Renal Dysfunction/Failure Critical Dependence on Pulse Pressure Hypertension. Circulation. 2007;115:733-742. 145. Palomba H, de Castro I, Neto AL, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney Int. 2007;72:624-631. 146. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999;130:461-470. 147. Balaguer JM, Umakanthan R, Leacche M, Byrne JG. Minimally invasive cardiac surgery. Curr Probl Surg. 2012;49:529-549. 148. Biancari F, Rimpilainen R. Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery. Heart. 2009;95:964-969. 149. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ; PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187-2198. 150. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597-1607. 151. Murzi M, Kallushi E, Tiwari KK, Cerillo AG, Bevilacqua S, Karimov JH, Solinas M, Glauber M. Minimally invasive mitral valve surgery through right thoracotomy in patients with patent coronary artery bypass grafts. Interact Cardiovasc Thorac Surg. 2009;9:29-32. 152. Suri RM, Schaff HV, Meyer SR, Hargrove WC 3rd. Thoracoscopic versus open mitral valve repair: a propensity score analysis of early outcomes. Ann Thorac Surg. 2009;88:1185-1190. 153. Modi P, Hassan A, Chitwood WJ. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2008;34:943- 952. 154. Harling L, Punjabi P, Athanasiou T. Miniaturized extracorporeal circulation versus Off-pump coronary artery bypass grafting: what the evidence shows? Perfusion. 2011;26:40-47. 155. Nigwekar SU, Kandula P, Hix JK, Thakar CV. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized and observational studies. Am J Kidney Dis. 2009;54:413-423. 156. Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, Lucke JC, Baltz JH, Novitzky D; Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group. Veterans Affairs Randomized On/Off Bypass Study Group: On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009;361:1827-1837. 157. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, Straka Z, Piegas LS, Akar AR, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Vaijyanath P, Reddy S, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Ng J, Chrolavicius S, Yusuf S; CORONARY Investigators. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med. 2012;366:1489-1497. 158. Chawla LS, Zhao Y, Lough FC, Schroeder E, Seneff MG, Brennan JM. Offpump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol. 2012;23:1389-1397. 159. Parolari A, Alamanni F, Gherli T, Bertera A, Dainese L, Costa C, Schena M, Sisillo E, Spirito R, Porqueddu M, Rona P, Biglioli P. Cardiopulmonary bypass and oxygen consumption: oxygen delivery and hemodynamics. Ann Thorac Surg. 1999;67:1320-1327. 160. Ranucci M. Perioperative renal failure: hypoperfusion during cardiopulmonary bypass? Semin Cardiothorac Vasc Anesth. 2007;11:265-268. 161. Haase M, Bellomo R, Story D, Letis A, Klemz K, Matalanis G, Seevanayagam S, Dragun D, Seeliger E, Mertens PR, Haase-Fielitz A. Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney injury. Nephrol Dial Transplant. 2012;27:193- 198. 162. Sirvinskas E, Benetis R, Raliene L, Andrejaitiene J. The influence of mean arterial blood pressure during cardiopulmonary bypass on postoperative renal dysfunction in elderly patients. Perfusion. 2012;27:193-198. 163. Poswal P, Mehta Y, Juneja R, Khanna S, Meharwal ZS, Trehan N. Comparative study of pulsatile and nonpulsatile flow during cardio-pulmonary bypass. Ann Card Anaesth. 2004;7:44-50. 164. Sink JD, Chitwood WR Jr, Hill RC, Wechsler AS. Comparison of nonpulsatile and pulsatile extracorporeal circulation on renal cortical blood flow. Ann Thorac Surg. 1980;29:57-62. 165. Rosner MH, Portilla D, Okusa MD. Cardiac surgery as a cause of acute kidney injury: pathogenesis and potential therapies. J Intensive Care Med;2008;23:3- 18. 166. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Engoren M, Durham SJ, Shah A. Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit Care Med. 2005;33:1749-1756. 167. Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, Djaiani G, Ivanov J, Karski J, David TE. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. Thorac Cardiovasc Surg. 2005;129:391-400. 168. Huybregts RA, de Vroege R, Jansen EK, van Schijndel AW, Christiaans HM, van Oeveren W. The association of hemodilution and transfusion of red blood cells with biochemical markers of splanchnic and renal injury during cardiopulmonary bypass. Anesth Analg. 2009;109:331-339. 169. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, Blackstone EH. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med. 2008;358:1229-1239. 170. Nalla BP, Freedman J, Hare GM, Mazer CD. Update on blood conservation for cardiac surgery. J Cardiothorac Vasc Anesth. 2012;26:117-133. 171. Boodhwani M, Rubens FD, Wozny D, Nathan HJ. Effects of mild hypothermia and rewarming on renal function after coronary artery bypass grafting. Ann Thorac Surg. 2009;87:489-495. 172. Vercaemst L. Hemolysis in cardiac surgery patients undergoing cardiopulmonary bypass: a review in search of a treatment algorithm. J Extra Corpor Technol. 2008;40:257-267. 173. Qian Q, Nath KA, Wu Y, Daoud TM, Sethi S. Hemolysis and acute kidney failure. Am J Kidney Dis. 2010;56:780-784. 174. Lau K, Shah H, Kelleher A, Moat N. Coronary artery surgery: cardiotomy suction or cell salvage? Cardiothorac Surg. 2007;2:46. 175. Nitescu N, Bengtsson A, Bengtson JP. Blood salvage with a continuous autotransfusion system compared with a haemofiltration system. Perfusion. 2002;17:357-362. 176. Doty JR, Wilentz RE, Salazar JD, Hruban RH, Cameron DE. Atheroembolism in cardiac surgery. Ann Thorac Surg. 2003;75:1221-1226. 177. Kokotsakit J, Lazopoulos G, Milonakis M, Athanasiadis G, Romana K, Skouteli E, Bastounis E. Right axillary artery cannulation for surgical management of the hostile ascending aorta. Tex Heart Inst J. 2005;32:189- 193. 178. Leite Filho OA, Brandão CM, Pomerantzeff PM, Guedes MA, Higuchi Mde L, Stolf NA. Particulate emboli capture by an intra-aortic filter device during aortic valve replacement. Rev Bras Cir Cardiovasc. 2008;23:431-435. 179. Haase M, Haase-Fielitz A, Bellomo R, Devarajan P, Story D, Matalanis G, Reade MC, Bagshaw SM, Seevanayagam N, Seevanayagam S, Doolan L, Buxton B, Dragun D. Sodium bicarbonate to prevent increases in serum creatinine after cardiac surgery: a pilot double-blind, randomized controlled trial. Crit Care Med, 2009;37:39-47. 180. Heringlake M, Heinze H, Schubert M, Nowak Y, Guder J, Kleinebrahm M, Paarmann H, Hanke T, Schön J. A peri-operative infusion of sodium bicarbonate does not improve renal function in cardiac surgery patients: a prospective observational cohort study. Crit Care. 2012;16:R156. 181. Bailey M, McGuinness S, Haase M, Haase-Fielitz A, Parke R, Hodgson CL, Forbes A, Bagshaw SM, Bellomo R. Sodium Bicarbonate and Renal Function after Cardiac Surgery: A Prospectively Planned Individual Patient Metaanalysis. Anesthesiology. 2015;122:294-306. 182. Ranucci M, De Benedetti D, Bianchini C, Castelvecchio S, Ballotta A, Frigiola A, Menicanti L. Effects of fenoldopam infusion in complex cardiac surgical operations: a prospective, randomized, double-blind, placebocontrolled study. Minerva Anestesiol. 2010;76:249-259. 183. Zangrillo A, Biondi-Zoccai GG, Frati E, Covello RD, Cabrini L, Guarracino F, Ruggeri L, Bove T, Bignami E, Landoni G. Fenoldopam and acute renal failure in cardiac surgery: a meta-analysis of randomized placebo-controlled trials. J Cardiothorac Vasc Anesth. 2012;26:407-413. 184. Ambwani J, Ubhrani D, Saad R, Dunning J. Could atrial natriuretic peptide be a useful drug therapy for high-risk patients after cardiac surgery? Interact Cardiovasc Thorac Surg. 2009;8:474-478. 185. Yoshitake I, Sezai A, Hata M, Niino T, Unosawa S, Wakui S, Shiono M. Lowdose atrial natriuretic peptide for chronic kidney disease in coronary surgery. Ann Thorac Cardiovasc Surg. 2011;17:363-368. 186. Sezai A, Hata M, Niino T, Yoshitake I, Unosawa S, Wakui S, Osaka S, Takayama T, Kasamaki Y, Hirayama A, Minami K. Influence of continuous infusion of low-dose human atrial natriuretic peptide on renal function during cardiac surgery: a randomized controlled study. J Am Coll Cardiol. 2009;54:1058-1064. 187. Lingegowda V, Van QC, Shimada M, Beaver TM, Dass B, Sood P, Ejaz AA. Long-term outcome of patients treated with prophylactic nesiritide for the prevention of acute kidney injury following cardiovascular surgery. Clin Cardiol. 2010;33:217-221. 188. Patel NN, Rogers CA, Angelini GD, Murphy GJ. Pharmacological therapies for the prevention of acute kidney injury following cardiac surgery: a systematic review. Heart Fail Rev. 2011;16:553-567. 189. Mitaka C, Kudo T, Haraguchi G, Tomita M. Cardiovascular and renal effects of carperitide and nesiritide in cardiovascular surgery patients: a systematic review and meta-analysis. Crit Care. 2011;15:R258. 190. Mentzer RM Jr, Oz MC, Sladen RN, Graeve AH, Hebeler RF Jr, Luber JM Jr, Smedira NG; NAPA Investigators. Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: the Napa Trial. J Am Coll Cardiol. 2007;49:716-726. 191. Ejaz AA, Martin TD, Johnson RJ, Winterstein AG, Klodell CT, Hess PJ Jr, Ali AK, Whidden EM, Staples NL, Alexander JA, House-Fancher MA, Beaver TM. Prophylactic nesiritide does not prevent dialysis or all-cause mortality in patients undergoing high-risk cardiac surgery. J Thorac Cardiovasc Surg. 2009;138:959-964. 192. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol, 2008;51:1419-1428. 193. Brown JR, Block CA, Malenka DJ, O'Connor GT, Schoolwerth AC, Thompson CA. Sodium bicarbonate plus N-acetylcysteine prophylaxis: a meta-analysis. JACC Cardiovasc Interv. 2009;2:1116-1124. 194. Lameire N, Kellum JA; KDIGO AKI Guideline Work Group. Contrastinduced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (part 2). Crit Care. 2013;17:205. 195. Ashworth A, Webb S. Does the prophylactic administration of Nacetylcysteine prevent acute kidney injury following cardiac surgery? Interact Cardiovasc Thorac Surg. 2010;11:303-308. 196. Nigwekar S, Kandula P. N-acetylcysteine in cardiovascular-surgery-associated renal failure: a meta-analysis. Ann Thorac Surg. 2009;87:139-147. 197. Adabag AS, Ishani A, Bloomfield HE, Ngo AK, Wilt TJ. Efficacy of Nacetylcysteine in preventing renal injury after heart surgery: a systematic review of randomized trials. Eur Heart J. 2009;30:1910-1917. 198. Schetz M, Bove T, Morelli A, Mankad S, Ronco C, Kellum JA. Prevention of cardiac surgery-associated acute kidney injury. Int J Artif Organs. 2008;31:179-189. 199. Elahi M, Asopa S, Pflueger A, Hakim N, Matata B. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg. 2009;35:854-863. 200. Roscitano A, Benedetto U, Goracci M, Capuano F, Lucani R, Sinatra R. Intraoperative continuous venovenous hemofiltration during coronary surgery. Asian Cardiovasc Thorac Ann. 2009;17:462-466. 201. Vidal S, Richebé P, Barandon L, Calderon J, Tafer N, Pouquet O, Fournet N, Janvier G. Evaluation of continuous veno-venous hemofiltration for the treatment of cardiogenic shock in conjunction with acute renal failure after cardiac surgery. Eur J Cardiothorac Surg. 2009;36:572-579. 202. Wang S, Palanzo D, Ündar A. Current ultrafiltration techniques before, during and after pediatric cardiopulmonary bypass procedures. Perfusion, 2012;27:438-446. 203. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Resp Crit Care Med. 2002;166:1338-1344. 204. Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation. 2009;119:3053-3061. 205. Zweig M, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993;39:561- 577. 206. Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, Landolfo K. Acute renal failure following cardiac surgery. Nephrol Dial Transplant. 1999;14:1158-1162. 207. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Ann Intern Med. 1998;128:194-203. 208. Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettilä V. Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg. 2006;81:542-546. 209. Portilla D, Dent C, Sugaya T, Nagothu KK, Kundi I, Moore P, Noiri E, Devarajan P. Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2008;73:465-472. 210. Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, Dent C, Devarajan P, Edelstein CL. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2006;70:199-203. 211. Wyckoff M, and Augoustides J. Advances in Acute Kidney Injury Associated with Cardiac Surgery: The Unfolding Revolution in Early Detection. Journal of Cardiothoracic and Vascular Anesthesia. 2012;26:340-345. 212. Zappitelli M, Bernier PL, Saczkowski RS, Tchervenkov CI, Gottesman R, Dancea A, Hyder A, Alkandari O. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int. 2009;76:885-892. 213. Zubicki A, Cittanova ML, Zaier K., Serum creatinine cannot predict renal impairment in the perioperative period. Br J Anaesth. 1998;80:7. 214. Ryckwaert F, Boccara G, Frappier JM, Colson PH. Incidence, risk factors, and prognosis of a moderate increase in plasma creatinine early after cardiac surgery. Crit Care Med. 2002;30:1495-1498. 215. Lassnigg A, Schmid ER, Hiesmayr M, Falk C, Druml W, Bauer P, Schmidlin D. Impact of minimal increases in serum creatinine on outcome in patients after cardio- thoracic surgery: do we have to revise current definitions of acute renal failure? Crit Care Med. 2008;36:1129-1137. 216. Ho J, Reslerova M, Gali B, Nickerson PW, Rush DN, Sood MM, Bueti J, Komenda P, Pascoe E, Arora RC, Rigatto C. Serum Creatinine Measurement Immediately After Cardiac Surgery and Prediction of Acute Kidney Injury. Am J Kidney. 2012;59:196-201. 217. Hajjar LA, Almeida JP, Fukushima JT, Rhodes A, Vincent JL, Osawa EA, Galas FR. High lactate levels are predictors of major complications after cardiac surgery. J Thorac Cardiovasc Surg. 2013;146:455-460. 218. Ranucci M, De Toffol B, Isgrò G, Romitti F, Conti D, Vicentini M. Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome. Crit Care. 2006;10:167. 219. Maillet JM, Le Besnerais P, Cantoni M, Nataf P, Ruffenach A, Lessana A, Brodaty D. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest. 2003;123:1361-1366. 220. Pinsky M. Beyond global oxygen supply-demand relations: in search of measures of dysoxia. Intensive Care Med. 1994;20:1-3. 221. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are superior to oxygen derived variables in predicting outcome in human septic shock. Chest. 1991;99:956-962. 222. Takala J, Usaro A, Parviainen I, Ruokonen E. Lactate metabolism and regional lactate exchange after cardiac surgery. New Horiz. 1996;4:483-492. 223. Chioléro RL, Revelly JP, Leverve X, Gersbach P, Cayeux MC, Berger MM, Tappy L. Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery. Crit Care Med. 2000;28:3784-3791. 224. Toraman F, Evrenkaya S, Yuce M, Aksoy N, Karabulut H, Bozkulak Y, Alhan C. Lactic acidosis after cardiac surgery is associated with adverse outcome. Heart Surg Forum. 2004;7:155-159. 225. Stainsby W, Eitzman P. Effects of adrenergic agonists and antagonists on muscle O2 uptake and lactate metabolism. J Appl Physiol. 1987;62:322-326. 226. Bellomo R. Bench-to-bedside review: lactate and the kidney. Crit Care. 2002;6:322-326. 227. Toraman F, Evrenkaya S, Yuce M, Aksoy N, Karabulut H, Bozkulak Y, Alhan C. Lactic acidosis after cardiac surgery is associated with adverse outcome. Heart Surg Forum. 2004;7:155-159. 228. Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, Sisillo E. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. Cardiothorac Vasc Anesth. 2008;22:814- 822. 229. Kumar AB, Suneja M, Bayman EO, Weide GD, Tarasi M. Association Between Postoperative Acute Kidney Injury and Duration of Cardiopulmonary Bypass: A Meta-Analysis. Journal of Cardiothoracic and Vascular Anesthesia. 2012;25:64-69. 230. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16:9 - 13. 231. Nashef SA, Roques F, Hammill BG, Peterson ED, Michel P, Grover FL, Wyse RK, Ferguson TB; EuroSCORE Project Group. Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg. 2002;22:101-105. 232. Kawachi Y, Nakashima A, Toshima Y, Arinaga K, Kawano H. Evaluation of the quality of cardiovascular surgery care using risk stratification analysis according to the EuroSCORE additive model. Circ J. 2002;66:145-148. 233. Toumpoulis IK, Anagnostopoulos CE, Swistel DG, DeRose JJ Jr. Does EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery? Eur J Cardiothorac Surg. 2005;27:128-133. 234. Toumpoulis IK, Anagnostopoulos CE, DeRose JJ, Swistel DG. Does EuroSCORE predict length of stay and specific postoperative complications after coronary artery bypass grafting? Internal Journal of Cardiology. 2005;105:19-25. 235. de Moura EB, Bernardes Neto SC, Amorim FF, Viscardi RC. Correlation of the EuroSCORE with the onset of postoperative acute kidney injury in cardiac surgery. Rev Bras Ter Intensiva. 2013;25:233-38. 236. Kennedy SA, McEllistrem B, Kinsella A, Fan Y, Boyce S, Murphy K, McCarthy JF, Wood AE, Watson RW. EuroSCORE and neutrophil adhesion molecules predict outcome post-cardiac surgery. Eur L Clin Invest. 2012;42:881-90. 237. Fellahi JL, Le Manach Y, Daccache G, Riou B, Gérard JL, Hanouz JL. Combination of EuroSCORE and Cardiac Troponin I Improves the Prediction of Adverse Outcome after Cardiac Surgery. Anesthesiology. 2011;114:330- 339. 238. Concato J, Feinstein AR, Holford TR. The risk of determining risk with multivariable models. Ann Intern Med. 1993;118:201-210. 239. Wells CK, Feinstein AR, Walter SD. A comparison of multivariable mathematical methods for predicting survival-III. Accuracy of predictions in generating and challenge sets. J Clin Epidemiol. 1990;43:361-372. 240. Harrell FE Jr, Lee KL, Califf RM, Pryor DB, Rosati RA. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984;3:143-153. 241. Elahi M, Asopa S, Pflueger A, Hakim N, Matata B. Acute Kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothoracic Surg. 2009;35:854-863. 242. Arnaoutakis GJ, Bihorac A, Martin TD, Hess PJ Jr, Klodell CT, Ejaz AA, Garvan C, Tribble CG, Beaver TM. RIFLE criteria for acute kidney injury in aortic arch surgery. J Thorac Cardiovasc Surg. 2007;134:1554-1560.