Preoperative estimated glomerular filtration rate and the risk of major adverse cardiovascular and cerebrovascular events in non-cardiac surgery (original) (raw)

2014, BJA: British Journal of Anaesthesia

† Chronic kidney disease is an important risk factor for perioperative complications. † In a post hoc analysis of a previous outcomes study, estimated glomerular filtration rate (eGFR) was assessed as a predictor of complications after non-cardiac surgery. † Major adverse cardiovascular and cerebrovascular events correlated inversely with preoperative eGFR. † This index of kidney function is useful for cardiovascular risk assessment in non-cardiac surgery. Background. Chronic kidney disease is an independent predictor of perioperative cardiovascular morbidity and mortality. We analysed the preoperative estimated glomerular filtration rate (eGFR) as a risk factor for perioperative major adverse cardiovascular and cerebrovascular events (MACCE) in non-cardiac surgery. Methods. In a post hoc analysis of the ANESCARDIOCAT database, patients were classified into six stages of eGFR calculated with the abbreviated Modification of Diet in Renal Disease Study and the Chronic Kidney Disease Epidemiology Collaboration equations: .90 (1), 60-89.9 (2), 45-59.9 (3a), 30-44.9 (3b), 15-29.9 (4), and ,15 (5) ml min 21 1.73 m 22. We analysed differences in MACCE, length of hospital stay, and all-cause mortality between eGFR stages. Results. The eGFR was available in 2323 patients. Perioperative MACCE occurred in 4.5% of patients and cardiac-related mortality was 0.5%. Five hundred and forty-three (23.4%) patients had an eGFR of ,60 ml min 21 1.73 m 22 and 127 (5.4%) had an eGFR below 45 ml min 21 1.73 m 22. Logistic regression analysis showed that MACCE increased with eGFR impairment (P,0.001), with a marked increase from stage 3b onwards (odds ratio 1.8 vs 3.9 in 3a and 3b, respectively, P¼0.047). All-cause mortality was not related to eGFR (P¼0.071), but increased substantially between stages 3b and 4. The length of stay correlated with eGFR (P,0.001). Conclusions. Perioperative MACCE increase with declining eGFR, primarily when ,45 ml min 21 1.73 m 22. We recommend the use of preoperative eGFR for cardiovascular risk assessment.