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Occult renal dysfunction: a mortality and morbidity risk factor in coronary artery bypass grafting surgery

Antonio Miceli1, Vito D Bruno, Radek Capoun

  • 1Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.

The Journal of Thoracic and Cardiovascular Surgery
|October 2, 2010
PubMed

Insights

Occult renal dysfunction, a condition with normal serum creatinine but reduced kidney function, significantly increases risks after coronary artery bypass grafting (CABG). This finding highlights the importance of assessing kidney function beyond standard creatinine levels in cardiac surgery patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Surgical Outcomes

Background:

  • Elevated preoperative serum creatinine is a known risk factor for adverse outcomes post-coronary artery bypass grafting (CABG).
  • The impact of occult renal dysfunction, characterized by normal serum creatinine with impaired glomerular filtration rate, remains understudied in CABG patients.

Purpose of the Study:

  • To investigate the association between occult renal dysfunction and early adverse outcomes in patients undergoing CABG.

Main Methods:

  • A retrospective cohort study analyzed prospectively collected data from 9159 patients with normal serum creatinine undergoing CABG.
  • Patients were stratified based on preoperative creatinine clearance (≥ 60 mL/min vs. < 60 mL/min) using the Cockcroft-Gault equation.

Main Results:

  • Occult renal dysfunction (creatinine clearance < 60 mL/min) was linked to a doubled risk of operative mortality (1.4% vs. 0.7%).
  • This group also showed significantly higher rates of postoperative renal dysfunction (5.1% vs. 2.5%), need for dialysis (0.8% vs. 0.4%), stroke (1% vs. 0.3%), and prolonged hospital stay (> 7 days).
  • Multivariable analysis confirmed occult renal dysfunction as an independent predictor for mortality, renal dysfunction, dialysis, stroke, arrhythmia, and extended hospital stay.

Conclusions:

  • Occult renal dysfunction is a significant independent risk factor for early mortality and morbidity following coronary artery bypass grafting.
  • Preoperative assessment of renal function, beyond serum creatinine, is crucial for risk stratification in CABG patients.
Abstract

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