Preoperative mild renal dysfunction in patients undergoing CABG was independently associated with increased in-hospital mortality (OR 1.91; 95% CI 1.18-3.03; P=0.007) and reduced 3-year survival.
Cohort (n=4,403)
No
Does preoperative mild renal dysfunction increase mortality and morbidity in patients undergoing first-time isolated CABG?
Preoperative mild renal dysfunction is an independent predictor of increased in-hospital mortality, stroke, need for dialysis, and reduced 3-year survival in patients undergoing first-time isolated CABG.
Odds Ratio: 1.91 (95% CI 1.18–3.03)
Absolute Event Rate: 6.1% vs 2.1%
p-value: p=0.007
BACKGROUND: Risk stratification algorithms for coronary artery bypass grafting (CABG) do not include a weighting for preoperative mild renal impairment defined as a serum creatinine 130 to 199 micromol/L (1.47 to 2.25 mg/dL), which may impact mortality and morbidity after CABG. METHODS AND RESULTS: We reviewed prospectively collected data between 1997 and 2004 on 4403 consecutive patients undergoing first-time isolated CABG with a preoperative serum creatinine <200 micromol/L (2.26 mg/dL)] in a single institution. The in-hospital mortality was 2.5% (112 of 4403), the need for new dialysis/hemofiltration was 1.3% (57 of 4403), and the stroke rate was 2.5% (108 of 4403). There were 458 patients with a serum creatinine 130 to 199 micromol/L or 1.47 to 2.25 mg/dL (mild renal dysfunction group) and 3945 patients with a serum creatinine <130 micromol/L (<1.47 mg/dL). Operative mortality was higher in the mild renal dysfunction group (2.1% versus 6.1%; P<0.001) and increased with increasing preoperative serum creatinine level. New dialysis/hemofiltration (0.8%versus 5.2%; P<0.001) and postoperative stroke (2.2% versus 5.0%; P<0.01) were also more common in the patients with mild renal impairment. Multivariate analysis adjusting for known risk factors confirmed preoperative mild renal impairment (creatinine 130 to 199 micromol/L or 1.47 to 2.25 mg/dL; odd ratio, 1.91; 95% CI, 1.18 to 3.03; P=0.007) or glomerular filtration rate estimates <60 mL/min per 1.73 m2, derived using the Cockroft-Gault formula, (odds ratio, 1.98; 95% CI, 1.16 to 3.48; P=0.015) as independent predictors of in-hospital mortality. Preoperative mild renal dysfunction adversely affected the 3-year survival probability after CABG (93% versus 81%; P<0.001). CONCLUSIONS: Mild renal dysfunction is an important predictor of outcome in terms of in-hospital mortality, morbidity, and midterm survival in patients undergoing CABG.
Zakeri et al. (Tue,) conducted a cohort in Coronary artery disease requiring CABG (n=4,403). Preoperative mild renal dysfunction (serum creatinine 130-199 micromol/L) vs. Normal renal function (serum creatinine <130 micromol/L) was evaluated on In-hospital mortality (OR 1.91, 95% CI 1.18-3.03, p=0.007). Preoperative mild renal dysfunction in patients undergoing CABG was independently associated with increased in-hospital mortality (OR 1.91; 95% CI 1.18-3.03; P=0.007) and reduced 3-year survival.