Insuficiência renal oculta acarreta risco elevado de mortalidade após cirurgia de revascularização miocárdica

Volkmann, Mathias Alexandre; Behr, Paulo E. B.; Burmeister, Jayme Eduardo; Consoni, Paulo Roberto Cardoso; Kalil, Renato A. K.; Prates, Paulo R.; Nesralla, Ivo Abraão; Sant'Anna, João Ricardo M

doi:10.5935/1678-9741.20110005

Cited by 7 publications

(5 citation statements)

References 20 publications

(30 reference statements)

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“…Despite recent advances in cardiovascular surgery kidney dysfunction is highly prevalent [1][2][3][4][5][6][7][8]. When dialysis is performed the mortality rate is increased by up eight times [9].…”

Section: Introductionmentioning

confidence: 99%

Influence of fresh frozen plasma as a trigger factor for kidney dysfunction in cardiovascular surgery

Parreiras¹,

Rocha²,

Martins³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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Section: Introductionmentioning

confidence: 99%

Influence of fresh frozen plasma as a trigger factor for kidney dysfunction in cardiovascular surgery

Parreiras¹,

Rocha²,

Martins³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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“… 4 Volkmann et al found that a preoperative SCr level >1.5 mg/dL doubled the risk of death and also produced a longer hospital stay. 15 Our previous study also showed that a preoperative SCr level >106 μmol/L is an important independent risk factor for postoperative AKI. 16…”

Section: Discussionmentioning

confidence: 85%

Reversible preoperative renal dysfunction does not add to the risk of postoperative acute kidney injury after cardiac valve surgery

Zhuang

Liu

et al. 2017

TCRM

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ObjectiveTo evaluate the impact of the renal dysfunction (RD) type and change of postoperative cardiac function on the risk of developing acute kidney injury (AKI) in patients who underwent cardiac valve surgery.MethodReversible renal dysfunction (RRD) was defined as preoperative RD in patients who had not been initially diagnosed with chronic kidney disease (CKD). Cardiac function improvement (CFI) was defined as postoperative left ventricular ejection function – preoperative left ventricular ejection function (ΔEF) >0%, and cardiac function not improved (CFNI) as ΔEF ≤0%.ResultsOf the 4,805 (94%) cardiac valve surgery patients, 301 (6%) were RD cases. The AKI incidence in the RRD group (n=252) was significantly lower than in the CKD group (n=49) (36.5% vs 63.3%, P=0.018). The AKI and renal replacement therapy incidences in the CFI group (n=174) were significantly lower than in the CFNI group (n=127) (33.9% vs 50.4%, P=0.004; 6.3% vs 13.4%, P=0.037). After adjustment for age, gender, and other confounding factors, CKD and CKD + CFNI were identified as independent risk factors for AKI in all patients after cardiac valve surgery. Multivariate logistic regression analysis showed that the risk factors for postoperative AKI in preoperative RD patients were age, gender (male), hypertension, diabetes, chronic heart failure, cardiopulmonary bypass time (every 1 min added), and intraoperative hypotension, while CFI after surgery could reduce the risk.ConclusionFor cardiac valve surgery patients, preoperative CKD was an independent risk factor for postoperative AKI, but RRD did not add to the risk. Improved postoperative cardiac function can significantly reduce the risk of postoperative AKI.

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“…However, most studies about preoperative renal dysfunction usually studied patients with eGFR < 60 mL/min /1.73 m 2 [6, 14], but the risk of patients with mild decreased eGFR (60~90 mL/min /1.73 m 2 ) and normal SCr is less evaluated. In the study by Howell et al including 7621 consecutive patients who underwent CABG, valve surgery or combined procedures, eGFR ≥ 90 mL/min /1.73 m 2 were considered normal renal function (reference group), eGFR 60–90 mL/min/1.73 m 2 were mild renal dysfunction (group 2), eGFR 30–59 mL/min/ 1.73 m 2 were moderate renal dysfunction (group 3) and eGFR 15–29 mL/min/1.73 m 2 were severe renal dysfunction (group 4) and the results showed that eGFR of 60–90 mL/min/1.73 m 2 (mild renal dysfunction) was an independent predictor of in-hospital and late mortality as well as cardiovascular complications [15], which is in line with our results, which revealed that for patients with normal SCr under the age of 65 years preoperative 60 ≤ eGFR< 90 mL/min/1.73 m 2 values became a risk factor for 3-year progressive CKD.…”

Section: Discussionmentioning

confidence: 99%

“…In the study of Volkmann et al, patients with plasma creatinine (PCr) ≤ 1.5 mg/dL who underwent CABG were divided into 2 groups, estimated creatinine clearance (eCrCl) ≥ 60 mL/min (normal renal function) or eCrCl < 60 mL/min (reduced renal function), respectively. The results showed that reduced renal function had a double risk of death, a longer total hospital stay and post-surgical hospital stay than those patients with normal renal function [6]. However, a considerable fraction of cardiac surgery patients may have normal SCr values and an eGFR under 90 mL/min/1.73 m 2 , but above 60 mL/min/1.73 m 2 , particularly since eGFR declines with age [7].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

J Cardiothorac Surg

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Background To study different value of estimated glomerular filtration rate with normal serum creatinine whether is a risk factor for hidden renal function of cardiac surgery outcomes. Methods A total of 1744 cardiac surgery patients with serum creatinine ≤1.2 mg/dL (female)/1.5 mg/dL (male) were divided into 3 groups: estimated glomerular filtration rate ≥ 90 mL/min/1.73 m 2 (no renal dysfunction, n = 829), 60 ≤ estimated glomerular filtration rate < 90 mL/min/1.73 m 2 (hidden renal dysfunction, n = 857), estimated glomerular filtration rate < 60 mL/min/1.73 m 2 (known renal dysfunction, n = 58) and followed up for 3 years. Multivariate regression analyses for risk factors of postoperative acute kidney injury. Results The proportion of preoperative hidden renal dysfunction was 67.1% among patients ≥ 65 years old and 44.1% among patients < 65 years old. Multivariate Cox regression analyses showed that for patients < 65 years, known renal dysfunction was a risk factor for postoperative acute kidney injury ( P < 0.01) and progressive chronic kidney disease ( P = 0.018), while hidden renal dysfunction was a risk factor for progressive chronic kidney disease ( P = 0.024). For patients ≥ 65 years, only known renal dysfunction was a risk factors for 3-year mortality ( P = 0.022) and progressive chronic kidney disease ( P < 0.01). Conclusion Hidden renal dysfunction was common in patients with normal serum creatinine for cardiac surgery, with a prevalence of 49.1%. For patients < 65 years old, hidden renal dysfunction was an independent risk factor for progressive chronic kidney disease.

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Insuficiência renal oculta acarreta risco elevado de mortalidade após cirurgia de revascularização miocárdica

Abstract: Insuficiência renal oculta acarreta risco elevado de mortalidade após cirurgia de revascularização miocárdicaHidden renal dysfunction causes increased inhospital mortality risk after coronary artery bypass graft surgery

Cited by 7 publications

References 20 publications

Influence of fresh frozen plasma as a trigger factor for kidney dysfunction in cardiovascular surgery

Influence of fresh frozen plasma as a trigger factor for kidney dysfunction in cardiovascular surgery

Reversible preoperative renal dysfunction does not add to the risk of postoperative acute kidney injury after cardiac valve surgery

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

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