The impact of mild renal dysfunction on isolated cardiopulmonary coronary artery bypass grafting: a retrospective propensity score matching analysis

Abstract

BackgroundMild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG.MethodsAfter propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60–89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria.ResultsThe 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09–2.90, p = 0.035; 95%CI 1.14–2.49, p = 0.027).ConclusionsComparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.

Acute kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: a retrospective propensity score matching analysis

“…Cox regression manifested that postoperative in-hospital AKI was a significant variable related to the new onset of dialysis and long-term mortality, and the HR was 1.83 and 1.31 respectively (95%CI 1.12–2.86, p = 0.007; 95%CI 1.17–2.58, p = 0.015). This study was consistent with our previous study and some other studies which demonstrated that development of AKI was associated with high short-term and long-term morbidity and mortality [ 18 , 26 ]. AKI has been associated with progression to chronic kidney disease(CKD) and dialysis in many reports [ 27 ].…”

Acute kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: a retrospective propensity score matching analysis

“…Cox regression manifested that postoperative in-hospital AKI was a signi cant variable related to the new onset of dialysis and long-term mortality, and the HR was 1.83 and 1.31 respectively (95%CI 1.12-2.86, p=0.007; 95%CI 1.17-2.58, p = 0.015). This study was consistent with our previous study and some other studies which demonstrated that development of AKI was associated with high short-term and long-term morbidity and mortality [18,27] . AKI has been associated with progression to chronic kidney disease(CKD) and dialysis in many reports [28] .…”

Innate immune response in the patients with heart disease and acute kidney injury after coronary artery bypass grafting, depending on the duration of extracorporeal circulation

“…ОПП, развившийся после АКШ, сопряжен с неблагоприятным прогнозом в раннем послеоперационном периоде, с ухудшением прогноза и качества жизни после выписки из стационара, а также высокой летальностью [5]. Применение ИК во время операций на открытом сердце является фактором риска развития ОПП, поскольку его использование ассоциировано с развитием воспалительной реакции, почечной гипоперфузией, гипотермией, гемодилюцией, а также с отсутствием пульсирующего кровотока [14]. В настоящее время остается открытым вопрос, может ли техника проведения ИК улучшить результаты АКШ.…”