Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery

Anderson, Robert J.; O’Brien, Maureen M.; MaWhinney, Samantha; Villanueva, Claudia; Möritz, Thomas; Sethi, Gulshan K.; Henderson, William G.; Hammermeister, Karl E.; Grover, Frederick L.; Shroyer, A. Laurie

doi:10.1046/j.1523-1755.1999.0550031057.x

Cited by 213 publications

(130 citation statements)

References 23 publications

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“…The mortality rate observed in patients without acute renal failure was 1.6%, compared with 25.0% for those with it. This rate was greater than that described in other studies, which remained between 1.3% and 22.3% [5][6][7][8]11,12,19,21 in patients with acute renal failure, and this incidence was correlated with a greater percentage of patients with acute renal failure-D, which has a higher mortality rate. However, the criteria that determined myocardial coronary artery bypass surgery (emergency or elective) related to a worse prognosis were not assessed in this study 15,17 .…”

Section: Discussioncontrasting

confidence: 57%

“…Acute renal failure, as a postoperative complication of heart surgery, is a severe event correlated with high mortality and morbidity rates 21,22 . Mortality ranges from 3.5% to 31.0% [5][6][7][8][9][10][11][12][16][17][18][19]23 , and this variation may be because of the criteria used for its diagnosis: the number and characteristics of hospitals involved in each study, the patients' features, and the size of the sample 11,24 .…”

Section: Discussionmentioning

confidence: 99%

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Insuficiência renal aguda após cirurgia de revascularização miocárdica com circulação extracorpórea: incidência, fatores de risco e mortalidade

Santos¹,

Silveira²,

Maia³

et al. 2004

Arq. Bras. Cardiol.

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150Acute renal failure is a severe condition that occurs in 2.0% to 7.0% of patients during hospital stay [1][2][3] . In 18.0% to 47.0% of cases, it is related to a surgical event, and acute tubular necrosis is the main type of lesion 1,2,4 . The great variation in the incidence of acute renal failure among the studies presents a multifactor profile, including different diagnostic criteria, such as the study design, inclusion and exclusion criteria, profile of the patients and of the centers involved in the sample, hindering study comparisons 5 .In cardiac surgery, its incidence ranges from 3.5% to 31.0% [5][6][7][8][9][10][11][12] , and the need for dialysis occurs in 0.3% to 15.0% of cases [5][6][7][8][9][10][11][12][13][14][15][16][17][18] . The presence of acute renal failure in these patients increases the mortality rate from 0.4% to 4.4% to 1.3% to 22.3%, and when dialysis is required, these rates reach 25.0% to 88.9% [5][6][7][8][9][10][11][12][13][14][15][16][17][18] , making it an independent risk factor for mortality, according to Chertow et al 16 , and increasing 8-fold the death odds ratio among these patients.The presence of conditions that determine hypoperfusion and renal ischemia are directly related to the development of ARF. Patients who present with reduced renal functional reserve, in whom a reduction occurs in the glomerular filtration rate without serum creatinine elevation above normal values, are more likely to have ARF even with minor renal lesions 16 . Preoperative and intraoperative factors, such as age, previous level of creatinine, diabetes mellitus, cardiac output, the duration of extracorporeal circulation, and the use of the intraaortic balloon, are influencial in the development of ARF [5][6][7][8][10][11][12]19 . The severity of ARF may increase with the occurrence of complications in the postoperative period, such as infections, hemorrhage, and the use of nephrotoxic substances 20 .In Brazil, few studies have reported the incidence of ARF after cardiac surgery, its risk factors, and its outcomes. The great impact of ARF in the outcomes of cardiac surgery demand its study in our population, encouraging to the elaboration of this study, which aims at identifying the incidence, risk factors, duration of ICU stay, and mortality due to ARF after myocardial coronary artery bypass surgery in a university hospital in Brazil. MethodsFrom 10/1/2001 to 9/30/2002, 223 of 247 patients undergoing myocardial coronary artery bypass surgery were prospectively studied. Exclusion criteria were: surgery without extracorporeal circulation (12 patients), death within the first 24h after surgery ConclusionAcute renal failure after myocardial coronary artery bypass surgery is a frequent complication associated with a high mortality rate. The independent risk factors are age, previous renal failure, and the need for inotropic drugs.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Insuficiência renal aguda após cirurgia de revascularização miocárdica com circulação extracorpórea: incidência, fatores de risco e mortalidade

Santos¹,

Silveira²,

Maia³

et al. 2004

Arq. Bras. Cardiol.

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“…A recent retrospective study of 3954 patients undergoing CABG surgery demonstrated mild renal insufficiency (serum creatinine 1.5 to 3.0 mg/dL) to be independently associated with higher 30-day mortality, postoperative bleeding, and ventilatory complications. 33 Complication rates were comparable to patients with severe renal insufficiency (serum creatinine Ͼ3.0 mg/dL). In the ESRD population, percutaneous revascularization may be associated with a high rate of restenosis.…”

Section: Discussionmentioning

confidence: 79%

“…Data on the effect of mild renal insufficiency in patients with coronary artery disease are limited. [31][32][33] Zanardo et al 31 reported higher morbidity and mortality rates after cardiac operations in patients with preexisting renal dysfunction (serum creatinine Ն1.5 mg/dL). Rao et al 32 studied 38 patients with mild renal dysfunction (serum creatinine Ͼ1.7 mg/dL) not requiring dialysis who underwent CABG surgery.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Implications of Abnormalities in Renal Function in Patients With Acute Coronary Syndromes

et al. 2002

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Background— Outcomes in patients with mild to moderate renal function (RF) abnormalities presenting with acute coronary syndromes (ACS) are not well defined. Methods and Results— A convenience sample of 4 ACS trial databases including all enrolled patients was assessed to determine 30- and 180-day outcomes. The 4 trials were Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb, GUSTO-III, Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT), and Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON-A). Patients were stratified into ST-segment elevation (STE) and non–ST-segment elevation (NSE) groups and by the presence or absence of abnormal RF (creatinine clearance <70 mL/min). In the STE group, 7670 of 18 621 patients (41%) had abnormal RF. In the NSE group, 8152 of 19 304 (42%) had abnormal RF. Patients with abnormal RF were older, more often female, and more likely to have adverse baseline characteristics. They had higher mortality and higher mortality/nonfatal myocardial infarction (MI) at both 30 and 180 days, regardless of ST-segment status. Creatinine clearance was independently associated with risk of mortality (hazard ratio 0.79 in the STE group and 0.81 in the NSE group) and with risk of mortality/MI (hazard ratio 0.93) in the NSE group at 180 days. Conclusions— Patients presenting with ACS frequently have abnormal RF. Abnormal RF is a marker of adverse baseline clinical characteristics and is independently associated with increased risk of death and death/MI.

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“…Another study showed similar data (36). A recent retrospective study of 3902 patients after coronary surgery demonstrated that even minor renal dysfunction was an independent risk factor for 30-d mortality (7% versus 3%; P Ͻ 0.001), a prolonged mechanical ventilation time (15% versus 8%; P ϭ 0.001), more stroke events (7% versus 2%; P Ͻ 0.001), and more bleeding complications (8% versus 3%; P Ͻ 0.001) (38). Although the currently available data appear to be more favorable for artery bypass grafting, it is important to bear in mind that most of these studies were performed before the widespread use of new anti-platelet regimens and of coronary stenting.…”

Section: Therapeutic Options For Patients With Renal Insufficiency Anmentioning

confidence: 99%

How Does Minor Renal Dysfunction Influence Cardiovascular Risk and the Management of Cardiovascular Disease?

Pinkau¹,

Hilgers²,

Veelken³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. This review focuses on the association between mild renal insufficiency (stage 2 and 3 of chronic kidney disease) and cardiovascular disease and discusses therapeutic options. Although the association of chronic renal insufficiency and cardiovascular risk was first shown in patients with end-stage renal disease, even minor renal dysfunction is now established as an independent risk for atherosclerotic cardiovascular disease. The association has been established in patients with a high cardiovascular risk but also in the general population. Treatment with angiotensin-converting enzyme inhibitors and statins can reduce cardiovascular morbidity and mortality in patients with renal insufficiency. Coronary revascularization improves the prognosis in patients with minor renal dysfunction, but there is still an underutilization of coronary revascularization procedures in people with renal insufficiency. The use of coronary stenting has now reduced the incidence of restenosis in these patients, and there is hope that the development of new devices will improve the prognosis in patients with renal insufficiency as well. Nevertheless, people with cardiovascular disease and renal insufficiency die significantly more often than people without renal insufficiency independent of prior successful treatment. Further investigations should focus on the causes of and possible preventive interventions for the staggering cardiovascular risk in the everincreasing number of people with minor renal dysfunction. Cardiovascular disease is common in patients with renal insufficiency. The association between renal insufficiency and cardiovascular disease was first shown in patients with end-stage renal disease, whose cardiovascular mortality exceeds that of patients without renal disease by a factor of 20 to 40. Even in adolescents with end-stage renal disease, there is a staggering cardiovascular risk (1). However, the impact of renal insufficiency on the development of atherosclerotic cardiovascular disease probably begins with minor renal dysfunction (2). Until recently, there was little evidence linking minor renal dysfunction (stage 2 and 3 of chronic kidney disease) to an increased cardiovascular risk. Here, we review the evidence and therapeutic options. Renal Insufficiency in People Not Selected for Cardiovascular Risk FactorsPatients with varying degrees of renal insufficiency have a predisposition to accelerated atherosclerosis and its consequences even in the absence of traditional cardiovascular risk factors (3). One of the first studies to assess minor renal dysfunction as a predictor of cardiovascular risk in a general population was the Framingham Heart Study (4); 6233 individuals with a mean age of 54 yr were followed for a mean of 15 yr. Minor renal dysfunction was present in 8% of women and 9% of men at baseline and was associated with a 40% greater all-cause mortality in men but not in women. However, there were only trends but no significant association between mild renal insufficiency and future cardiovascula...

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Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery

Abstract: These results demonstrate that mild renal failure is an independent risk factor for adverse outcome after CABG.

Cited by 213 publications

References 23 publications

Insuficiência renal aguda após cirurgia de revascularização miocárdica com circulação extracorpórea: incidência, fatores de risco e mortalidade

Insuficiência renal aguda após cirurgia de revascularização miocárdica com circulação extracorpórea: incidência, fatores de risco e mortalidade

Prognostic Implications of Abnormalities in Renal Function in Patients With Acute Coronary Syndromes

How Does Minor Renal Dysfunction Influence Cardiovascular Risk and the Management of Cardiovascular Disease?

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