What does this research mean for the field?

In cardiac surgery patients under 65 years old with normal serum creatinine, preoperative hidden renal dysfunction is an independent risk factor for progressive chronic kidney disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 22, 2019Journal of Cardiothoracic SurgeryOpen Access

Preoperative hidden renal dysfunction add an age dependent risk of progressive chronic kidney disease after cardiac surgery

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Cardiac surgery patients with normal serum creatinine (n=1744). Intervention: Hidden renal dysfunction (60 ≤ eGFR < 90 mL/min/1.73 m2) vs. No renal dysfunction (eGFR ≥ 90 mL/min/1.73 m2). Primary outcome: Progressive chronic kidney disease at 3 years (in patients < 65 years) (HR 1.690, 95% CI 1.071-2.669, p=0.024).

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Key result

Preoperative hidden renal dysfunction linked to ~69% higher 3-year progressive CKD risk after cardiac surgery.

HR 1.690
95% CI 1.071-2.669
P=0.024
n=1,744

Why the study?

The risk associated with different levels of estimated glomerular filtration rate despite normal serum creatinine in cardiac surgery outcomes was unclear.

Does preoperative hidden renal dysfunction increase the risk of progressive chronic kidney disease and acute kidney injury in patients undergoing cardiac surgery?

Population

1744 cardiac surgery patients with normal serum creatinine

Comparison

Hidden renal dysfunction vs no renal dysfunction vs known renal dysfunction

Design

Observational cohort study

Follow-up

3 years

Authors

JXJiarui XuSun Yat-sen University JYJiawei YuWeifang Medical University XXXialian XuShanghai Medical College of Fudan University

Discussion

Member takes

Implication

May warrant preoperative eGFR screening in younger cardiac surgery patients despite normal creatinine; hypothesis-generating and requires prospective validation before practice change.

Study Design

Type

Observational (n=1,744)

Multicenter

Structured PICO

Does preoperative hidden renal dysfunction increase the risk of progressive chronic kidney disease and acute kidney injury in patients undergoing cardiac surgery?

Population

1,744 adult patients with normal serum creatinine undergoing cardiac surgery, followed for 3 years to assess the impact of hidden renal dysfunction.

Exposure

Preoperative hidden renal dysfunction (estimated glomerular filtration rate 60 to <90 mL/min/1.73 m2)

Comparator

No renal dysfunction (estimated glomerular filtration rate ≥90 mL/min/1.73 m2) and known renal dysfunction (estimated glomerular filtration rate <60 mL/min/1.73 m2)

Outcome

Postoperative acute kidney injury and progressive chronic kidney diseasehard clinical

Main Result

Hazard Ratio: 1.69 (95% CI 1.071–2.669)

Absolute Event Rate: 5.36% vs 2.47%

p-value: p=0.024

Preoperative hidden renal dysfunction (eGFR 60-89 mL/min/1.73 m2 with normal serum creatinine) is highly prevalent and represents an independent risk factor for progressive chronic kidney disease after cardiac surgery in patients under 65 years of age.

Limitations

Observational and retrospective study in a single center
Possible unmeasured confounding factors
Mild renal dysfunction is poorly defined and the study used arbitrary serum creatinine cut-offs

Cite This Study

Xu et al. (2019) conducted an observational in Cardiac surgery patients with normal serum creatinine (n=1,744). Hidden renal dysfunction (60 ≤ eGFR < 90 mL/min/1.73 m2) vs. No renal dysfunction (eGFR ≥ 90 mL/min/1.73 m2) was evaluated on Progressive chronic kidney disease at 3 years (in patients < 65 years) (HR 1.690, 95% CI 1.071-2.669, p=0.024). In cardiac surgery patients under 65 years old with normal serum creatinine, preoperative hidden renal dysfunction independently increased the risk of progressive chronic kidney disease at 3 years (HR 1.69).

synapsesocial.com/papers/6aae22eb4d420f8d34879fb3 https://doi.org/10.1186/s13019-019-0977-9

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Implication

May warrant preoperative eGFR screening in younger cardiac surgery patients despite normal creatinine; hypothesis-generating and requires prospective validation before practice change.

Preoperative hidden renal dysfunction add an age dependent risk of progressive chronic kidney disease after cardiac surgery

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Preoperative hidden renal dysfunction add an age dependent risk of progressive chronic kidney disease after cardiac surgery

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider