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Renal function and outcome from coronary artery bypass grafting: impact on mortality after a 2.3-year follow-up
Graham S Hillis1, Bernie L Croal, Keith G Buchan
1Department of Cardiology, University of Aberdeen, Aberdeen Royal Infirmary, UK. g.hillis@abdn.ac.uk
Insights
Estimated glomerular filtration rate (eGFR) predicts mortality after coronary artery bypass graft surgery (CABG). Lower eGFR indicates a higher risk of death, making it a valuable tool for assessing patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Surgical Outcomes
Background:
- Severe kidney dysfunction worsens outcomes after coronary artery bypass graft surgery (CABG).
- Previous studies used serum creatinine, an insensitive marker of kidney function.
- Estimated glomerular filtration rate (eGFR) may be a more accurate measure for predicting outcomes.
Purpose of the Study:
- To evaluate the utility of eGFR in predicting mortality after CABG.
- To determine if eGFR is a better predictor than traditional risk scores.
Main Methods:
- Studied 2067 patients undergoing CABG.
- Calculated eGFR using the Modification of Diet in Renal Disease equation.
- Followed patients for a median of 2.3 years to assess all-cause mortality.
Main Results:
- Mean eGFR was lower in patients who died (57.9 mL/min/1.73 m2) compared to survivors (64.7 mL/min/1.73 m2).
- eGFR was an independent predictor of mortality (HR 0.71 per 10 mL/min/1.73 m2, P<0.001).
- eGFR remained a significant predictor even when included in risk models (HR 0.80, P<0.001; HR 0.88, P=0.02).
Conclusions:
- Estimated glomerular filtration rate (eGFR) is a powerful predictor of mortality after CABG.
- eGFR provides valuable prognostic information beyond traditional risk factors.
Background:
Severe renal dysfunction is associated with a worse outcome after coronary artery bypass graft surgery (CABG). Less is known about the effects of milder degrees of renal impairment, and previous studies have relied on levels of serum creatinine, an insensitive indicator of renal function. Recent studies have suggested that estimated glomerular filtration rate (eGFR) is a more discriminatory measure. However, data on the utility of eGFR in predicting outcome from CABG are limited.
Methods And Results:
We studied 2067 consecutive patients undergoing CABG. Demographic and clinical data were collected preoperatively, and patients were followed up a median of 2.3 years after surgery. Estimated GFR was calculated from the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. Mean+/-SD eGFR was 57.9+/-17.6 mL/min per 1.73 m2 in the 158 patients who died during follow-up compared with 64.7+/-13.8 mL/min per 1.73 m2 in survivors (hazard ratio [HR], 0.71 per 10 mL/min per 1.73 m2; 95% CI, 0.64 to 0.80; P<0.001). Estimated GFR was an independent predictor of mortality in both models with other individual univariable predictors (HR, 0.80 per 10 mL/min per 1.73 m2; 95% CI, 0.72 to 0.89; P<0.001) and the European system for cardiac operative risk evaluation (HR, 0.88 per 10 mL/min per 1.73 m2; 95% CI, 0.78 to 0.98; P=0.02).
Conclusions:
Estimated GFR is a powerful and independent predictor of mortality after CABG.
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