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Evaluating surrogate measures of renal dysfunction after cardiac surgery
Duminda N Wijeysundera1, Vivek Rao, W Scott Beattie
1*Department of Anaesthesia, University of Toronto; †Division of Cardiac Surgery, Toronto General Hospital, University Health Network; ‡Department of Anaesthesia, University Health Network, University of Toronto; and §Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Anesthesia and Analgesia
|April 23, 2003
Summary
Evaluating renal function after cardiac surgery is crucial. Both serum creatinine change and creatinine clearance change effectively predict adverse outcomes like dialysis and mortality, with clearance offering a statistically advantageous normal distribution.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Renal insufficiency post-cardiac surgery increases mortality and ICU stay.
- A reliable surrogate measure is needed for evaluating renal-protective therapies.
Purpose of the Study:
- To evaluate the 72-h change in serum creatinine (DeltaCr(72h)) and % change in calculated creatinine clearance (%DeltaCrCl(72h)) as surrogate measures.
- To assess their association with dialysis, mortality, and prolonged ICU stay.
Main Methods:
- Randomly selected 2000 patients undergoing cardiac surgery.
- Analyzed DeltaCr(72h) and %DeltaCrCl(72h) using histograms, normal probability plots, and ROC curves.
- Assessed prediction of dialysis, mortality, and prolonged hospitalization.
Main Results:
- DeltaCr(72h) was right-skewed; %DeltaCrCl(72h) was normally distributed.
- Both measures showed similar, strong predictive power for dialysis, mortality, and hospitalization.
- ROC curve areas did not significantly differ between the two measures.
Conclusions:
- Both DeltaCr(72h) and %DeltaCrCl(72h) are valid surrogate outcomes for cardiac surgery trials.
- Calculated creatinine clearance offers a normal distribution, facilitating parametric statistical analysis.
- These measures can aid in evaluating renal-protective strategies.