The effect of preoperative renal dysfunction with or without dialysis on early postoperative outcome following cardiac surgery (original) (raw)
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European Journal of Cardio-Thoracic Surgery, 2008
Objectives: To assess the impact of preoperative renal dysfunction on in-hospital mortality and late survival outcome following adult cardiac surgery. Methods: Prospectively collected data were analysed on 7621 consecutive patients not requiring preoperative renal-replacement therapy, who underwent CABG, valve surgery or combined procedures from 1/1/98 to 1/12/06. Preoperative estimated glomerular filtration rate was calculated using Cockcroft-Gault formula. Patients were classified in the four chronic kidney disease (CKD) stage classes defined by the National Kidney Foundation Disease Outcome Quality Initiative Advisory Board. Late survival data were obtained from the UK Central Cardiac Audit Database. Results: There were 243 in-hospital deaths (3.2%). There was a stepwise increase in operative mortality with each CKD class independent of the type of surgery. Multivariate analysis confirmed CKD class to be an independent predictor of in-hospital mortality (class 2 OR 1.45, 95% CI 1.1-2.35, p = 0.001; class 3 OR 2.8, 95% CI 1.68-4.46, p = 0.0001; class 4 OR 7.5, 95% CI 3.76-15.2, p = 0.0001). The median followup after surgery was 42 months (IQR 18-74) and there were 728 late deaths. Survival analysis using a Cox regression model confirmed CKD class to be an independent predictor of late survival (class 2 HR 1.2, 95% CI 1.1-1.6, p = 0.0001; class 3 HR 1.95, 95% CI 1.6-2.4, p = 0.0001; and class 4 HR 3.2, 95% CI 2.2-4.6, p = 0.0001). Ninety-eight percent (7517/7621) of patients had a preoperative creatinine <200 mmol/l, which is not included as a risk factor in most risk stratification systems. Conclusions: Mild renal dysfunction is an important independent predictor of in-hospital and late mortality in adult patients undergoing cardiac surgery. #
Journal of the American Society of Nephrology, 2004
Postoperative renal function deterioration is a serious complication after cardiac surgery with cardiopulmonary bypass and is associated with increased in-hospital mortality. However, the long-term prognosis of patients with postoperative renal deterioration is not fully determined yet. Therefore, both in-hospital mortality and long-term survival were studied in patients with postoperative renal function deterioration. Included were 843 patients who underwent cardiac surgery with cardiopulmonary bypass in 1991. Postoperative renal function deterioration (increase in serum creatinine in the first postoperative week of at least 25%) occurred in 145 (17.2%) patients. In these patients, in-hospital mortality was 14.5%, versus 1.1% in patients without renal function deterioration (P < 0.001). Multivariate analysis significantly associated in-hospital mortality with postoperative renal function deterioration, re-exploration, postoperative cerebral stroke, duration of operation, age, and diabetes. In patients who were discharged alive, during long-term follow-up (100 mo), mortality was significantly increased in the patients with renal function deterioration (n ؍ 124) as compared with those without renal function deterioration (hazard ratio 1.83; 95% confidence interval 1.38 to 3.20). Also after adjustment for other independently associated factors, the risk for mortality in patients with postoperative renal function deterioration remained elevated (hazard ratio 1.63; 95% confidence interval 1.15 to 2.32). The elevated risk for long-term mortality was independent of whether renal function had recovered at discharge from hospital. It is concluded that postoperative renal function deterioration in cardiac surgical patients not only results in increased in-hospital mortality but also adversely affects long-term survival.
The Internet Journal of Anesthesiology, 2007
Objective: To evaluate the effects of preoperative renal dysfunction on the outcome of the patients after cardiac surgery. Methods: From January 2002 to march 2005, cardiac surgery (coronary artery bypass grafting or valve replacement) was performed in 30 patients with preoperative renal dysfunction (creatinine > 2.0mg/dl) and in 220 patients without renal dysfunction. Hospital outcomes were compared between propensity-matched pairs of 30 patients with renal dysfunction (Renal group) and without renal dysfunction (Control group). Results: In the matched pairs, the early postoperative clinical results showed patients in the renal group were more likely to develop postoperative renal failure (p=<0.0001). The ventilatory support time, the intensive care and hospital stay were significantly higher in the renal group. The ventilatory support time was approximately three folds that for patients with renal dysfunction as for patients without (p=<0.0001). The mean length of stay in critical care units and hospital wards were approximately twice that for patients with renal dysfunction as for patients without (p=<0.01). The hospital mortality was higher in the renal group than the control group (10% vs. 3%, p=0.01, respectively). Conclusion: Renal dysfunction increases the morbidity and mortality in patients undergoing cardiac surgery. It is associated with longer ventilation time, intensive care unit and hospital stay. However, surgery in this patient population can be performed with acceptable morbidity and mortality rates compared to general patient population. A careful perioperative management and proper choice of therapeutic strategies may be useful for improvement of the outcome.
Interactive cardiovascular and thoracic surgery, 2008
It is well known that end-stage renal failure requiring dialysis negatively impacts early and late outcome of cardiac surgery. However, data with respect to non-dialysis-dependent renal failure patients (NDRF) are limited. We retrospectively analyzed 6940 consecutive patients undergoing cardiac surgery from January 1998 to September 2006. Patients undergoing cardiac transplantation and ventricular assist device implantation (n=246) and dialysis dependent patients (n=245) were excluded. NDRF was present in 135 (2.1%) patients (mean age 64+/-14, 38% female). NRDF patients were more likely to present with cardiac related risk factors including ejection fraction <30% (P<0.001), prior myocardial infarction (P<0.001), congestive heart failure…
Interactive cardiovascular and thoracic surgery, 2007
Acute renal failure requiring continuous renal replacement therapy post cardiac surgery carries a high mortality. Most studies have focused on patients with impaired renal function preoperatively but little is known about predictors of such a complication in patients with preoperatively normal renal function. This is a retrospective review of a prospective collected database. A total of 1609 patients underwent cardiac surgery over a 4-year period. Dialysis was required in 47 patients (2.9%). Univariate analysis identified the following as significant risk factors: age, female gender, chronic obstructive pulmonary disease, congestive cardiac failure, creatinine clearance, Euro, Parsonnet and Cleveland clinic scores, body mass index, non-isolated CABG, cardiopulmonary bypass time, extubation time and pulmonary complications (P<0.05). Multivariate analysis identified EuroSCORE, congestive cardiac failure, insulin-dependent diabetes, emergency surgery, postoperative extubation time a...