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Published on: January 28, 2020
Risk factors for deterioration of renal function after coronary artery bypass grafting
Albert H M van Straten1, Mohamed A Soliman Hamad, André A A J van Zundert
1Department of Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Insights
This study identified key risk factors for kidney function decline after coronary artery bypass grafting (CABG). Advanced age, diabetes, and specific pre-existing conditions increase the risk of postoperative renal impairment.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Postoperative renal function impairment after coronary artery bypass grafting (CABG) is a significant concern.
- Existing literature shows varied definitions and identified risk factors for renal dysfunction post-CABG.
Purpose of the Study:
- To identify specific risk factors associated with a 10% or greater deterioration in creatinine clearance following isolated coronary artery bypass grafting (CABG).
Main Methods:
- Prospective collection of clinical data from 10,626 patients undergoing isolated CABG between 1998 and 2007.
- Calculation of creatinine clearance using pre- and postoperative serum creatinine levels.
- Analysis to determine risk factors for a ≥10% decline in creatinine clearance.
Main Results:
- A 10% or greater deterioration in creatinine clearance was observed in 1053 patients (9.9%).
- Identified risk factors include advanced age, diabetes, COPD, peripheral vascular disease, emergency surgery, prior cardiac surgery, low hemoglobin, high CRP, perioperative MI, re-exploration, and blood transfusions.
- Peripheral vascular disease, previous cardiac surgery, low preoperative hemoglobin, elevated preoperative CRP, perioperative myocardial infarction, and number of blood transfusions were newly identified risk factors.
Conclusions:
- Established risk factors for renal function deterioration post-CABG were confirmed.
- Novel risk factors such as peripheral vascular disease, previous cardiac surgery, low preoperative hemoglobin, elevated preoperative CRP, perioperative myocardial infarction, and blood transfusion volume were identified.
Objective:
Various definitions of impairment of renal function after coronary artery bypass grafting (CABG) are used in the literature. Depending on the definition, several risk factors are identified. We analysed our data to determine the risk factors for postoperative deterioration of the creatinine clearance of 10% or more.
Methods:
All patients undergoing isolated coronary surgery in a single centre between January 1998 and December 2007 are included. Clinical data, including demographics and renal risk factors, were prospectively collected in our database. The most recent preoperative serum creatinine level and the maximum serum creatinine level within the first week postoperatively were used to calculate the creatinine clearance. A deterioration of 10% or more was considered to be an endpoint for this study.
Results:
In 10098 out of a total of 10626 patients, the preoperative as well as the postoperative creatinine clearance could be calculated. In 1053 patients, the deterioration of the creatinine clearance was 10% or more. We could identify the following risk factors: advanced age, diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, emergency operation, previous cardiac surgery, low preoperative haemoglobin level, high preoperative C-reactive protein level, perioperative myocardial infarction, re-exploration and the number of blood transfusions.
Conclusions:
Risk factors for the deterioration of renal function after revascularisation have been confirmed in this study. In addition, we found peripheral vascular disease, previous cardiac surgery, low preoperative haemoglobin, increased preoperative C-reactive protein level, perioperative myocardial infarction and the number of blood transfusions to be risk factors that have not been described earlier.
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