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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Chronic kidney disease as a risk factor for bleeding complications after coronary artery bypass surgery
Wolfgang C Winkelmayer1, Raisa Levin, Jerry Avorn
1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. wolfgang@post.harvard.edu
Insights
Chronic kidney disease (CKD) increases the risk of postoperative bleeding after coronary artery bypass graft (CABG) surgery. This risk is present even with mild renal impairment, highlighting the importance of kidney function assessment before CABG.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure.
- Postoperative bleeding is a significant complication following CABG.
- The role of chronic kidney disease (CKD) as a risk factor for this bleeding requires further definition.
Purpose of the Study:
- To investigate the association between chronic kidney disease (CKD) and the risk of postoperative bleeding in patients undergoing coronary artery bypass graft (CABG) surgery.
- To determine if varying stages of renal impairment correlate with increased bleeding risk post-CABG.
Main Methods:
- Retrospective cohort study of 238 patients undergoing isolated CABG.
- Significant postoperative bleeding defined by transfusion requirements or surgical revision.
- Glomerular filtration rate (GFR) calculated using the Cockroft-Gault formula.
- Multiple logistic regression analysis adjusted for multiple covariates.
Main Results:
- Mild renal impairment (GFR 61-80 mL/min) showed an elevated risk (OR, 2.11).
- Moderate renal impairment (GFR 41-60 mL/min) significantly increased bleeding risk (OR, 3.87).
- Severe renal impairment (GFR ≤40 mL/min) demonstrated a six-fold increase in bleeding odds (OR, 6.51) compared to GFR >100 mL/min.
Conclusions:
- Chronic kidney disease (CKD) is a significant risk factor for postoperative bleeding after CABG.
- The risk of bleeding is elevated even at mild stages of renal impairment.
- Preoperative assessment of kidney function is crucial for stratifying bleeding risk in CABG patients.
Background:
The aim of the study is to define the role of chronic kidney disease (CKD) as a risk factor for postoperative bleeding in patients undergoing coronary artery bypass graft (CABG) surgery.
Methods:
This is a retrospective cohort study of 238 consecutive patients who underwent isolated CABG surgery. Patients were followed up for the event of a significant bleed, defined as administration of either three or greater units of packed red blood cells, three or greater units of platelets, three or greater units of fresh frozen plasma, or any cryoprecipitate within 72 hours after a CABG procedure or undergoing a surgical revision for bleeding. Glomerular filtration rate (GFR) at baseline was calculated using the Cockroft-Gault formula. A final multiple logistic regression model was selected from a large set of presurgical and intraoperative covariates by using backward elimination (P > 0.20).
Results:
After controlling for age, sex, elective versus emergent surgery, intraoperative activated clotting time, serum albumin level, extracorporeal bypass time, and baseline hematocrit, we found that even mild levels of renal impairment were associated with increased risk for postoperative bleeding: patients with a GFR of 40 mL/min or less had six times the odds of postoperative bleeding than patients with a GFR greater than 100 mL/min (odds ratio [OR], 6.51; 95% confidence interval [CI], 1.87 to 22.66); those with a GFR of 41 to 60 mL/min had nearly four times the risk (OR, 3.87; 95% CI, 1.21 to 12.35). Even patients with mild CKD at a GFR of 61 to 80 mL/min were at an elevated risk (OR, 2.11); however, the 95% CI of 0.79 to 5.64 included the null value. Similar results were found when using the cruder Kidney Disease Outcomes Quality Initiative classification of CKD.
Conclusion:
CKD is associated with risk for postoperative bleeding in patients undergoing CABG surgery, not only at more advanced stages, but probably at relatively mild levels of renal impairment, as well.
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