Impact of Chronic Kidney Disease on Patient Outcome following Cardiac Surgery

Hedley, Adam J; Roberts, Matthew A; Hayward, Philip; Shaw, Margaret; Matalanis, George; Buxton, Brian F.; Farouque, Omar; Ierino, Francesco L.

doi:10.1016/j.hlc.2010.03.005

Cited by 26 publications

(14 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this same cohort, the hazard ratios for late mortality were 1.2, 1.95, and 3.2 for CKD stages 2, 3, and 4 respectively when followed out to a median of 42 months 23 . Hedley et al demonstrated an increase in operative mortality of 35-43% for every decrease of 10 mL/min/1.73m 2 in preoperative estimated glomerular filtration rate (eGFR) in patients undergoing CABG 24 . Even minimal increases in preoperative serum creatinine or decreases in eGFR that still remain within established normal reference ranges have been associated with increased mortality, infection, RRT requirement, and cerebrovascular accidents 26 .…”

Section: Outcomes - Mortalitymentioning

confidence: 99%

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Lysak

Bïhorac

Hobson

2017

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose Acute and chronic kidney diseases (AKI and CKD) have far-reaching implications for surgical patients in regards to postoperative outcomes and hospital cost. We review the recent literature on the effects of AKI and CKD on morbidity, mortality, and resource utilization among cardiac surgery patients. Recent findings Both AKI and CKD increase the risk for short and long-term mortality, morbidity, length of stay, and hospital cost among postoperative patients, with increasing disease stage correlating with worse outcomes. Even the mildest forms of AKI (RIFLE-R) and CKD (proteinuria without an observed reduction in eGFR) demonstrate worse clinical outcomes compared to patients with no AKI or CKD. Outcomes are worse even in patients who achieve full renal recovery before hospital discharge. These complications dramatically increase ICU length of stay, hospital length of stay, resource utilization, and both in-hospital and post-discharge costs, as evidenced by lower rates of discharges to home. Summary Acute and chronic kidney diseases remain prevalent, morbid, and costly conditions for cardiac surgery patients. Better risk stratification, early diagnosis, and earlier interventions are needed to prevent the consequences of these diseases.

show abstract

Section: Outcomes - Mortalitymentioning

confidence: 99%

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Lysak

Bïhorac

Hobson

2017

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…Several recent studies yielded similar results and concluded that CKD is common in the cardiac surgery population and preoperative ‘mild-to-moderate’ renal dysfunction is an important predictor of outcome in terms of in-hospital mortality, morbidity and midterm survival [4,8,9,10]. However, most of these studies assessed the association between renal function and outcome after cardiac surgery by dichotomizing renal function, using a serum creatinine level between 1.4 and 2.2 mg/dl as a cutoff point to diagnose ‘mild renal dysfunction’.…”

Section: Discussionmentioning

confidence: 90%

Influence of Minimal Changes in Preoperative Renal Function on Outcomes of Cardiac Surgery

Shavit¹,

Tauber

Lifschitz³

et al. 2012

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Cardiovascular morbidity and mortality are high in patients with chronic kidney disease. We evaluated the influence of small differences in preoperative kidney function on mortality and complications following cardiac surgery. Methods: This is an observational study that included adult patients undergoing cardiac surgery. Preoperative estimated glomerular filtration rate (eGFR) was estimated by the 4-component Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on preoperative creatinine levels. For analysis, patients were divided into groups according to their preoperative creatinine (0.2 mg/dl increments) and eGFR levels (15–30 ml/min/1.73 m² decrements). Results: Data on 5,340 patients were analyzed. A significant increase in postoperative mortality was demonstrated with preoperative creatinine at high-normal versus low-normal values (OR 1.7, 95% CI: 1–2.5; p = 0.02). For preoperative creatinine >1.2 mg/dl, adjusted OR for in-hospital mortality increased stepwise with every 0.2-mg/dl increment of creatinine. In addition, a statistically significant increment of mortality was detected with every 15-ml/min/1.73 m² decrement in preoperative eGFR. Conclusions: Minimal changes of preoperative kidney function are associated with a substantial increase in the risk of mortality and morbidity following cardiac surgery. Even within the ‘normal’ range, minimal increases in serum creatinine levels are associated with increased risk of adverse events postoperatively.

show abstract

“…Two studies by Mac et al 30 and Polkinghorne et al 31 were excluded due to overlapping populations with those recorded in the annual ANZDATA report. Since data from Wang et al 32 and Venuthurupalli et al 31 studies were both based on the CKD.QLD 32 was excluded due to the presence of participants with acute kidney injuries. Nine studies and 18 reports with 36 cohorts were included in the review.…”

Section: Results Of the Searchesmentioning

confidence: 99%

Prevalence and risk factors of peripheral artery disease in a population with chronic kidney disease in Australia: A systematic review and meta‐analysis

Chih

Garimella

et al. 2021

Nephrology

View full text Add to dashboard Cite

There is a lack of clarity and guidance for screening peripheral artery disease (PAD) in persons with chronic kidney disease (CKD) and end stage kidney disease (ESKD) despite this group being at excess risk of cardiovascular disease (CVD). In this current study, we performed a systematic review and meta-analysis to examine the prevalence and risk factors for PAD in persons with CKD in Australian cohorts. We used the inverse variance heterogeneity meta-analysis with double arcsine transformation to summarize the prevalence of PAD (with 95% CIs). Nine studies and 18 reports from the Australia and New Zealand dialysis and transplant registry with 36 cohorts were included in the review. We found a substantially higher PAD prevalence in cohorts based on an anklebrachial index (ABI) or toe systolic pressure (TBI) than cohorts based on self-reported history. Higher PAD prevalence was observed in ESKD persons than CKD persons without dialysis (PAD diagnosis based on ABI or TBI: 31% in ESKD persons and 23% in CKD persons, PAD diagnosis based on self-reported history: 17% in ESKD persons and 10% in CKD persons). Older age, Caucasian race, cerebrovascular disease and haemodialysis were associated with the presence of PAD in ESKD persons. Our findings indicated a considerable proportion of PAD in CKD and ESKD persons particularly in those with ESKD. To develop and provide an adequate plan to clinically manage CKD patients with PAD, evidence of cost-effectiveness and clinical benefit of early detection of PAD in persons with CKD in Australia is recommended for future studies.

show abstract

Impact of Chronic Kidney Disease on Patient Outcome following Cardiac Surgery

Cited by 26 publications

References 26 publications

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Influence of Minimal Changes in Preoperative Renal Function on Outcomes of Cardiac Surgery

Prevalence and risk factors of peripheral artery disease in a population with chronic kidney disease in Australia: A systematic review and meta‐analysis

Contact Info

Product

Resources

About