NDT Advance Access originally published online on January 4, 2008
Nephrology Dialysis Transplantation 2008 23(6):1970-1974; doi:10.1093/ndt/gfm908
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Costs and outcomes of acute kidney injury (AKI) following cardiac surgery
1 College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA 2 School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA 3 Abbott Laboratories, Department of Clinical Affairs, Chicago, IL, USA 4 College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA 5 The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Correspondence and offprint requests to: John A. Kellum, The CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 604 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. Tel: +1-412-647-8110; Fax: +1-412-647-3791; E-mail: kellumja{at}upmc.edu
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Abstract |
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Background. Acute kidney injury (AKI) is a recognized complication of cardiac surgery; however, the variability in costs and outcomes reported are due, in part, to different criteria for diagnosing and classifying AKI. We determined costs, resource use and mortality rate of patients. We used the serum creatinine component of the RIFLE system to classify AKI.
Methods. A retrospective cohort study was conducted from the electronic data repository at the University of Pittsburgh Medical Center of patients who underwent cardiac surgery and had an elevation (
0.5 mg/dl) of serum creatinine postoperatively. Data were compared to age- and APACHE III-matched controls. Cost, mortality and resource use of AKI patients were determined postoperatively for each of the three RIFLE classes on the basis of changes in serum creatinine.
Results. Of the 3741 admissions, 258 (6.9%) had AKI and were classified as RIFLE-R 138 (3.7%), RIFLE-I 70 (1.9%) and RIFLE-F 50 (1.3%). Total and departmental level costs, length of stay (LOS) and requirement for renal replacement therapy (RRT) were higher in AKI patients compared to controls. Statistically significant differences in all costs, mortality rate and requirement for RRT were seen in the patients stratified into RIFLE-R, RIFLE-I and RIFLE-F. Even patients with the smallest change in serum creatinine, namely RIFLE-R, had a 2.2-fold greater mortality, a 1.6-fold increase in ICU LOS and 1.6-fold increase in total postoperative costs compared to controls.
Discussion. Costs, LOS and mortality are higher in postoperative cardiac surgery patients who develop AKI using RIFLE criteria, and these values increase as AKI severity worsens.
Keywords: acute renal failure; CABG; costs; RIFLE
Received for publication: 7. 9.07
Accepted in revised form: 29.11.07
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