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

Abstract

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.

Impact of sarcopenia on the progress of cardiac rehabilitation and discharge destination after cardiovascular surgery

“…Like sarcopenia, kidney disease was also an outcome-effected factor in this study. Kidney disease has been reported to worsen many outcomes, such as prolonged LOS in the ICU and the hospital, delayed independence in 100 m walking, and increased mortality, because of high incidence of composite cardiovascular events and difficulty in medical administration, such as fluid balance 23 , 30 , 31 , 32 ) . To achieve early home discharge, not only cardiac rehabilitation, but also the strict kidney management at post-surgery, are important.…”

Identification of risk factors for acute kidney injury after pulmonary endarterectomy with cardiopulmonary bypass

“…It must be emphasized that alone use of this variable to assess baseline renal function has a limited value, as many factors can significantly affect preoperative SCr levels. The available evidence indicates that preoperative occult renal dysfunction, a most established risk factor for postoperative AKI, is common among patients with a normal SCr level, with a prevalence of 49.1% [2]. In clinical practice, the useful and reliable methods to determine preoperative occult renal dysfunction actually are combined use of SCr levels and SCr clearance, and use of estimated glomerular filtration rate criteria of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Classification.…”