Creatinine clearance and risk of early mortality in patients undergoing coronary artery bypass grafting
Related Experiment Video
Updated: Aug 16, 2026
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Martin J Holzmann1, Staffan Ahnve, Niklas Hammar
1Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden. martin.holzmann@karolinska.se
Insights
Calculated creatinine clearance predicts early mortality after coronary artery bypass grafting. This measure is superior to serum creatinine concentration for assessing patient risk.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Medical Statistics
Background:
- Renal function is crucial in cardiovascular surgery outcomes.
- Assessing renal insufficiency preoperatively aids in risk stratification for coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate calculated creatinine clearance as a predictor of early mortality and complications after CABG.
- To compare the predictive superiority of calculated creatinine clearance versus serum creatinine for postoperative death.
Main Methods:
- Included 6,711 patients undergoing first isolated CABG without dialysis-dependent renal insufficiency.
- Related preoperative serum creatinine and calculated creatinine clearance (Cockcroft-Gault) to 30-day postoperative mortality.
- Utilized multivariate analyses and receiver operating characteristic curves.
Main Results:
- Moderate and severe renal insufficiency significantly predicted early mortality (ORs 2.4 and 4.8, respectively).
- Calculated creatinine clearance demonstrated superior predictive ability (AUC 0.71) compared to serum creatinine (AUC 0.62).
- No increased risk of mediastinitis or bleeding was found in patients with renal insufficiency.
Conclusions:
- Moderate to severe renal insufficiency independently increases early death risk post-CABG.
- Calculated creatinine clearance is a more effective predictor of postoperative mortality than serum creatinine concentration.
Objectives:
We sought to evaluate renal function assessed on the basis of calculated creatinine clearance as a predictor of early mortality and postoperative complications in patients undergoing coronary artery bypass grafting and to assess whether calculated creatinine clearance is superior to serum creatinine concentration in predicting early death postoperatively.
Methods:
Six thousand seven hundred eleven consecutive patients without dialysis-dependent renal insufficiency undergoing a first isolated coronary artery bypass grafting were included. Preoperative serum creatinine concentrations and creatinine clearance calculated by using the Cockroft-Gault formula were related to mortality within 30 days postoperatively.
Results:
There were 136 early deaths. After adjustment for age and other confounders in multivariate analyses, moderate (calculated creatinine clearance 30-60 mL/min) and severe (calculated creatinine clearance < 30 mL/min) renal insufficiency predicted early mortality (odds ratio of 2.4 [95% confidence interval, 1.2-4.8] and odds ratio of 4.8 [95% confidence interval], 1.6-13.9, respectively) compared with normal (calculated creatinine clearance > or = 90 mL/min) renal function. The area under the receiver operating characteristic curve for calculated creatinine clearance and serum creatinine concentration was 0.71 and 0.62, respectively, yielding a difference of 0.08 (P = .0004). No increased risk of mediastinitis or bleeding was observed in patients with renal insufficiency.
Conclusion:
Moderate and severe renal insufficiency independently increase the risk of early death after coronary artery bypass grafting. Our results indicate that calculated creatinine clearance is a better predictor of early mortality postoperatively than serum creatinine concentration.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:25Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance
01:23Renal Clearance
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...
01:08Renal Drug Clearance: Comparison Between Renal Excretion Methods
Renal clearance is often associated with the renal glomerular filtration rate (GFR), which represents the rate at which plasma is filtered through the glomeruli in the kidney. When drug reabsorption is minimal and there is no active secretion, renal clearance is closely related to the...
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:06Renal Drug Clearance: Overview
Renal clearance can be calculated using different methods. One approach is to divide the urinary drug excretion rate by the plasma drug concentration. This method directly measures renal clearance, indicating the kidneys' efficiency in...