Serum Creatinine Patterns in Coronary Bypass Surgery Patients With and Without Postoperative Cognitive Dysfunction

Abstract

We previously noted that patients with postcardiac surgery stroke also have greater acute renal injury than unaffected patients. However, in the same setting, we found no difference in renal injury between patients with and without cognitive dysfunction. Factors responsible for subtle postoperative cognitive dysfunction do not appear to be associated with clinically important renal effects.

Predictors of Early Neurocognitive Deficits in Low-Risk Patients Undergoing On-Pump Coronary Artery Bypass Surgery

“…Interestingly, another study, evaluating 282 patients, specifically examined the relationship between serum creatinine and postoperative cognitive decline and was unable to establish an association. 18 This discordance may be caused by a lack of power, misspecification of the covariates, or the different time frame of neurocognitive testing. In our cohort, preoperative serum creatinine was a strong predictor of cognitive decline and demonstrated a threshold relationship with the risk of POCDs with sharp increases in the odds of POCDs at creatinine levels Ͼ125 mmol/L.…”

Renal Recovery After Acute Kidney Injury and Long-term Outcomes

“…The study by Bhatraju et al 2 study additionally highlights the shortfall of current AKI staging criteria used alone in assessing outcomes, as the severity stage by itself did not differentiate among which patients would develop MAKE; rather, the recovery pattern was more informative. This finding was similarly seen in the coronary artery bypass graft3 and intensive care unit 4 cohort studies and in aggregate emphasizes the need for clinicians to consider the patient's course after AKI as a determinant of outcome.Although there is now increasing interest in understanding the timing of recovery to identify distinct phenotypes prone to adverse outcomes, it is important to realize that these are just initial pieces of the puzzle. For instance, the ability to distinguish recovery from nonrecovery and the timing thereof depends on the definitions used.…”

“…The study by Bhatraju et al 2 study additionally highlights the shortfall of current AKI staging criteria used alone in assessing outcomes, as the severity stage by itself did not differentiate among which patients would develop MAKE; rather, the recovery pattern was more informative. This finding was similarly seen in the coronary artery bypass graft 3 and intensive care unit 4 cohort studies and in aggregate emphasizes the need for clinicians to consider the patient's course after AKI as a determinant of outcome.…”

“…Prior studies in different settings have examined these issues. In a cohort of 10 275 patients undergoing coronary artery bypass grafting, Swaminathan et al 3 showed the percentage decline in serum creatinine concentration within the first 24 hours from the peak value was the factor best associated with 1-year survival in the 1113 patients with AKI. Kellum et al 4 determined 5 different patterns of renal recovery after AKI in a single-center cohort of patients in the intensive care unit and showed that those with sustained nonrecovery had the highest mortality during hospitalization.…”

Association between Serum Creatinine and Cognitive Impairment in US Older Adults

“…Serum creatinine (Cre) has emerged as an indicator of renal function and has garnered considerable research interest as a predictor of various medical conditions, including diabetes, cardiovascular disease, pregnancy, and obesity [13][14][15][16][17][18]. Consequently, the investigation into the association between serum Cre and cognitive function has gained momentum [19][20][21][22][23][24]. One study reported no statistically signi cant link between lower Cre clearance and cognitive impairment [24].…”