Outcome of Renal Insufficiency Patients Undergoing Coronary Artery Bypass Graft Surgery

Abstract

Renal insufficiency (RI) is a prognostic marker in patients with cardiovascular disease. In this study, the latest standard of glomerular filtration rate (GFR) calculation, that is the modification of diet in renal disease (MDRD) study equation, is used to measure the difference in the outcome of coronary artery bypass graft (CABG) surgery in various GFR groups. Between 2000 and 2005, 1,055 patients underwent CABG surgery and were categorized into 5 groups according to the National Kidney Foundation guidelines: stage 1 = normal renal function; stage 2 = mild RI; stage 3 = moderate RI; stage 4 = severe RI; stage 5 = end-stage renal failure (excluded). Precautions were taken in RI patients to avoid perioperative hypotension, fluid overload and limited cardioplegia; cardiopulmonary bypass time was kept at a minimum by performing an essential number of grafts only. Thirty-day mortality occurred in 5 of 1,052 patients (0.48%) with no statistical difference in stages 1–4. There was increase in bleed requiring reoperation and total complications from stages 1 to 4, but it was not statistically significant. Preoperative renal dysfunction in CABG surgery patients is an important predictor of outcome. Patients undergoing CABG surgery can have acceptable results without significant increase in complications and mortality provided that risk factors are minimized perioperatively.

In Search of Strategies for Optimizing Outcomes in Patients with Compromised Renal Function Undergoing Coronary Artery Bypass Grafting

“…Chirumamilla and coworkers [8] have again demonstrated, as we have, that estimation of GFR unmasks chronic renal failure in some of the patients with normal serum creatinine levels. Their study reinforces the need for routine evaluation of renal function by GFR, calculated using the MDRD study equation, in patients undergoing CABG.…”

“…In this issue of Cardiology, Chirumamilla and coworkers [8] report a retrospective study comparing the outcomes of isolated primary CABG in groups of patients with mild (GFR 60-89 ml/min/1.73 m 2 ; n = 569), moderate (GFR 30-59 ml/min/1.73 m 2 ; n = 230) and severe (GFR 15-29 ml/min/1.73 m 2 ; n = 24) renal insufficiency with a group of patients with normal renal function (GFR 6 90 ml/min/1.73 m 2 ; n = 229). A total of 1,055 patients in this study were categorized into 5 groups according to the National Kidney Foundation guidelines based on GFR.…”

The Importance of Histopathological Findings in Saphenous Vein Grafts

“…Such factors are: the coronary anatomy before the bypass procedure, the anatomical features of the graft (e.g. arterial or venous graft and the histopathologic features), comorbid diseases (including diabetes, hyperlipidemia, hypertension, smoking and renal failure [4]) and the effectiveness of medical treatment. …”

Incremental prognostic value of kidney function decline over coronary artery disease for cardiovascular event prediction after coronary computed tomography

“…16 Nevertheless, CKD is an important marker of prognosis in different populations of patients with CAD. Studies of patients presenting with non-ST elevation MI 17 as well as patients undergoing coronary artery bypass graft surgery 18,19 or percutaneous coronary intervention 20 have demonstrated that reduced eGFR is associated with increased event rates.…”