Preoperative creatinine clearance as a predictor of short-term outcomes after cardiac surgery: a cohort study for the comparison between the Cockroft–Gault and modification of diet in renal disease formulae

Luciani, Remo; Lazzarino, Antonio Ivan; Capuano, Fabio; Benedetto, Umberto; Goracci, Massimo; Pirozzi, Nicola; Sinatra, Riccardo

doi:10.2459/jcm.0b013e328336b558

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…Rising CPB and ACC time led to increased serum creatinine and reduced GFR in all the patients. It seemed that aminophylline independent of other confounding factors such as CPB and ACC time, preoperation GFR, and creatinine could influence GFR and Cr; this finding is consistent with other studies demonstrating that prolonged time of CPB and cross-clamp affected serum Cr levels and GFR as useful parameters for postoperative renal injury ( 18 , 19 ).…”

Section: Discussionsupporting

confidence: 89%

Evaluation of the Effect of Aminophylline in Reducing the Incidence of Acute Kidney Injury After Cardiac Surgery

2017

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ObjectivesAcute renal failure is a common complication of major cardiovascular surgeries (One-third of patients). Adenosine release as a vascular vasodilator increases after cardiac surgery, which reduces renal and glomerular blood flow and subsequently causes kidney ischemic damage. The present study aimed at evaluating the impact of aminophylline as an adenosine receptor antagonist on renal function after cardiac surgery hoping to find an appropriate method to reduce acute kidney injury.MethodsThe patients in the intervention group received 5 mg/kg aminophylline bolus after induction of anesthesia; then, 0.25 mg/kg/hr of the drug was administered intraoperatively and up to 48 hours after surgery in the ICU cardiac surgery. Similar volume of normal saline was injected to the patients of the second group. Serum BUN, Cr, and GFR were measured pre- and postoperatively and 3 days postsurgery. Patients’ 24- hour urine output and RIFLE were also calculated.ResultsThose patients who received medication were extubated earlier (P = 0.018) and received lower amount of inotropic drugs (P < 0001). According to the RIFLE criteria, most of the patients experienced no change or even improved GFR and Cr amounts compared to the control group (p < 0.05). GFR and Cr value of all the patients with Cleveland score, less and more than 6, showed a significant difference between the 2 groups (P = 0.001 and P = 0.01, respectively). According to the RIFLE criteria, most of the patients experienced no change or even improved GFR.ConclusionsAminophylline in cardiac surgery can reduce the frequency of acute kidney injury according to RIFLE criteria and could be used in the prevention of AKI as a safe and efficient modality in high-risk patients. Also, the use of this drug may reduce the need for inotropic medication at the time of surgery, intensive care unit stay length, and extubation time.

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Section: Discussionsupporting

confidence: 89%

Evaluation of the Effect of Aminophylline in Reducing the Incidence of Acute Kidney Injury After Cardiac Surgery

2017

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“…Numerous studies about the prognostic value of the eGFR(MDRD) in cardiovascular diseases for clinical outcomes, such as mortality, have been published. [ 56 , 90 , 91 , 92 , 93 , 94 ] In patients with end-stage heart failure, irreversibly impaired renal function precludes eligibility for heart transplantation. [ 95 ] In addition, patients with cardiovascular diseases are at risk for polypharmacy and the use of drugs that require dosage adjustment in renal impairment.…”

Section: Methodsmentioning

confidence: 99%

Individualizing Pharmacotherapy in Patients with Renal Impairment: The Validity of the Modification of Diet in Renal Disease Formula in Specific Patient Populations with a Glomerular Filtration Rate below 60 Ml/Min. A Systematic Review

Eppenga¹,

Kramers

Derijks

et al. 2015

PLoS ONE

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BackgroundThe Modification of Diet in Renal Disease (MDRD) formula is widely used in clinical practice to assess the correct drug dose. This formula is based on serum creatinine levels which might be influenced by chronic diseases itself or the effects of the chronic diseases. We conducted a systematic review to determine the validity of the MDRD formula in specific patient populations with renal impairment: elderly, hospitalized and obese patients, patients with cardiovascular disease, cancer, chronic respiratory diseases, diabetes mellitus, liver cirrhosis and human immunodeficiency virus.Methods and FindingsWe searched for articles in Pubmed published from January 1999 through January 2014. Selection criteria were (1) patients with a glomerular filtration rate (GFR) < 60 ml/min (/1.73m2), (2) MDRD formula compared with a gold standard and (3) statistical analysis focused on bias, precision and/or accuracy. Data extraction was done by the first author and checked by a second author. A bias of 20% or less, a precision of 30% or less and an accuracy expressed as P30% of 80% or higher were indicators of the validity of the MDRD formula. In total we included 27 studies. The number of patients included ranged from 8 to 1831. The gold standard and measurement method used varied across the studies. For none of the specific patient populations the studies provided sufficient evidence of validity of the MDRD formula regarding the three parameters. For patients with diabetes mellitus and liver cirrhosis, hospitalized patients and elderly with moderate to severe renal impairment we concluded that the MDRD formula is not valid. Limitations of the review are the lack of considering the method of measuring serum creatinine levels and the type of gold standard used.ConclusionIn several specific patient populations with renal impairment the use of the MDRD formula is not valid or has uncertain validity.

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“…When comparing the prognostic values of these equations, the CG formula is generally favored as was the case in our study. The CG formula was a better predictor than the MDRD equation of early outcomes after PCI 11 and cardiac surgery 12 . Between the MDRD and CKD‐EPI equations, the latter outperforms the MDRD equation for predicting risk of mortality and end‐stage renal disease, 36 while similar prognostic values between the two were found in other cohorts 8,10,13 .…”

Section: Discussionmentioning

confidence: 84%

“…The CG formula was a better predictor F I G U R E 2 Kaplan-Meier curves of survival by estimated glomerular filtration rate (eGFR) quartiles calculated with the Modification of Diet in Renal Disease (MDRD) equation preoperatively (A) and postoperatively (B) than the MDRD equation of early outcomes after PCI 11 and cardiac surgery. 12 Between the MDRD and CKD-EPI equations, the latter outperforms the MDRD equation for predicting risk of mortality and end-stage renal disease, 36 while similar prognostic values between the two were found in other cohorts. 8,10,13 Comparing all three kidney function equations, the CG formula was better in predicting mortality in patients after PCI for acute STEMI at 6-year follow-up 9 and proved to be more accurate in predicting cardiovascular mortality.…”

Section: Discussionmentioning

confidence: 86%

“…[2][3][4] In evaluating renal function, calculating estimated glomerular filtration rates (eGFR) remains most useful, 5 Many studies examined the predictive value of individual equations for morbidity and mortality, but fewer compared these equations in populations [6][7][8] or following interventions, [9][10][11] including cardiac surgery. 12,13 There are currently no studies comparing the prognostic value of these five equations regarding long-term survival after cardiac surgery. Determining which provides a better prognostic value would be beneficial.…”

Section: Introductionmentioning

confidence: 99%

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Reassessment of kidney function equations in predicting long‐term survival in cardiac surgery

et al. 2020

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Background/Objectives Chronic kidney disease (CKD) is a risk factor for long‐term survival in cardiac surgery. The Cockcroft‐Gault, Modification of Diet in Renal Disease (MDRD) study, CKD Epidemiology Collaboration (CKD‐EPI), revised Lund‐Malmö (LM), and full age spectrum equations are used to estimate glomerular filtration rates (eGFR), but each have advantages and disadvantages. Our objective was to determine which equation better predicts long‐term survival. Methods Data on 1492 consecutive patients who underwent isolated off‐pump coronary artery bypass surgery between September 1996 and December 2008 were prospectively collected. Preoperative and postoperative eGFR were calculated using the five equations and compared using Cox regression analyses and time‐dependent receiver operating characteristic (ROC) curves at 10 years. Results In a Cox regression model after correction for significant predictors of long‐term mortality, adjusted hazard ratios (HR) for one standard deviation increase in preoperative eGFR were 0.661 (P < .0001), 0.844 (P = .0166), 0.787 (P = .0002), 0.746 (P < .0001), and 0.717 (P < .0001) for the CG, MDRD, CKD‐EPI, LM, and FAS equations, respectively. The areas under the time‐dependent ROC curve at 10 years also showed that the CG formula has a better predictive value. Postoperative eGFR at discharge were also significant predictors of long‐term mortality (HR = 0.603, P < .0001; HR = 0.725, P < .0001; HR = 0.688, P < .0001; HR = 0.673, P < .0001; HR = 0.632, P < .0001 for the CG, MDRD, CKD‐EPI, LM, and FAS equations, respectively). Conclusions The CG formula was shown to better predict survival in cardiac surgery, though the FAS equation has a comparable prognostic value. Additionally, postoperative eGFR at discharge also predicted long‐term survival.

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Preoperative creatinine clearance as a predictor of short-term outcomes after cardiac surgery: a cohort study for the comparison between the Cockroft–Gault and modification of diet in renal disease formulae

Cited by 6 publications

References 18 publications

Evaluation of the Effect of Aminophylline in Reducing the Incidence of Acute Kidney Injury After Cardiac Surgery

Evaluation of the Effect of Aminophylline in Reducing the Incidence of Acute Kidney Injury After Cardiac Surgery

Individualizing Pharmacotherapy in Patients with Renal Impairment: The Validity of the Modification of Diet in Renal Disease Formula in Specific Patient Populations with a Glomerular Filtration Rate below 60 Ml/Min. A Systematic Review

Reassessment of kidney function equations in predicting long‐term survival in cardiac surgery

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