Intraoperative Renal Regional Oxygen Desaturation Can Be a Predictor for Acute Kidney Injury after Cardiac Surgery

ObjectiveTo evaluate the usefulness of renal regional oxygen saturation (renal rSO2) in predicting the risk of acute kidney injury (AKI) after cardiac surgery.DesignA prospective observational study.SettingTertiary care university hospital.ParticipantsOne hundred patients undergoing cardiac surgery.InterventionsRenal rSO2 was monitored continuously by near-infrared spectroscopy (NIRS) throughout the anesthetic period.Measurements and Main ResultsPostoperative AKI was defined using the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Of 95 patients who were included in the final analysis, 34 patients developed AKI after surgery. Recorded renal rSO2 data were used to calculate the total duration of the time when renal rSO2 was below the threshold values of 70%, 65%, 60%, 55%, and 50%. The total periods when the renal rSO2 level was below each of the threshold values were significantly longer in patients with AKI than in those without AKI (p = 0.001 or p<0.001). Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of renal rSO2 for AKI. The ROC curve analysis showed that renal rSO2 could predict the risk of AKI with statistical significance and that a renal rSO2<55% had the best performance (area under the curve–ROC, 0.777; 95% CI, 0.669-0.885; p<0.001). Multivariate logistic regression analysis revealed that AKI significantly correlated with the duration of renal rSO2<55% (p = 0.002) and logistic EuroSCORE (p = 0.007).ConclusionsIntraoperative renal regional oxygen desaturation can be a good predictor of AKI in adult patients undergoing cardiac surgery.