Related Experiment Video

Updated: May 30, 2026

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
09:02

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Published on: February 2, 2021

Which method of estimating renal function is the best predictor of mortality after coronary artery bypass grafting?

A H M van Straten1, M A Soliman Hamad, B M J A Koene

  • 1Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA, Eindhoven, the Netherlands.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|August 18, 2011
PubMed

Insights

Creatinine clearance (CrCl) best predicts mortality after coronary artery bypass graft (CABG) surgery. This method, using the Cockcroft-Gault formula, offers superior prediction for early and late mortality compared to other renal function estimates.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Statistics

Background:

  • Estimating renal function in patients undergoing coronary artery bypass graft (CABG) surgery lacks standardized definitions.
  • Varied methods for assessing renal function may impact the accuracy of predicting patient outcomes post-CABG.

Purpose of the Study:

  • To determine the optimal method for estimating renal function as a predictor of mortality following CABG.
  • To compare the predictive power of serum creatinine (SeCr), creatinine clearance (CrCl), and estimated glomerular filtration rate (e-GFR) for CABG patient mortality.

Main Methods:

  • Analysis of preoperative and postoperative renal function data from 9987 patients undergoing isolated CABG (1998-2007).
  • Renal function was estimated using SeCr, CrCl (Cockcroft-Gault formula), and e-GFR (MDRD formula).
  • Receiver operator characteristic (ROC) curves were utilized to assess discriminatory power.

Main Results:

  • Creatinine clearance (CrCl) demonstrated the highest discriminatory power for predicting both early and late mortality.
  • Estimated glomerular filtration rate (e-GFR) showed moderate predictive ability, while serum creatinine (SeCr) was the least effective.
  • Preoperative parameters generally showed stronger associations with early mortality than postoperative parameters.

Conclusions:

  • The Cockcroft-Gault formula for creatinine clearance (CrCl) is the most effective method for predicting early and late mortality after CABG.
  • The relationship between renal function and mortality is non-linear, suggesting limitations in current risk stratification models.
  • Reconsideration of renal function assessment within risk scoring systems like EuroSCORE is warranted.
Abstract

Related Concept Videos

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...
Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate01:25

Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate

The glomerular filtration rate (GFR) is a critical indicator of kidney health, reflecting how well the kidneys filter blood. Changes in GFR can signal potential kidney impairment, necessitating accurate measurement methods to monitor kidney function effectively.Various molecules can serve as markers for GFR measurement, with the ideal marker meeting several specific criteria. It must freely filter at the glomerulus, avoid reabsorption or secretion by the renal tubules, remain unmetabolized, not...
Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance (Clcr), a...
Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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...
Kaplan-Meier Approach01:24

Kaplan-Meier Approach

The Kaplan-Meier estimator is a non-parametric method used to estimate the survival function from time-to-event data. In medical research, it is frequently employed to measure the proportion of patients surviving for a certain period after treatment. This estimator is fundamental in analyzing time-to-event data, making it indispensable in clinical trials, epidemiological studies, and reliability engineering. By estimating survival probabilities, researchers can evaluate treatment effectiveness,...
Determination of Renal Drug Clearance: Graphical and Midpoint Methods01:07

Determination of Renal Drug Clearance: Graphical and Midpoint Methods

Renal clearance, a crucial parameter in pharmacokinetics, can be determined using two different methods: the graphical method and the midpoint method. These methods provide insights into the rate of drug excretion by the kidneys and aid in assessing renal function.
The graphical method involves plotting the rate of drug excretion in urine against the plasma drug concentration. By analyzing the graph, the clearance can be calculated and obtained. Drugs rapidly excreted by the kidneys exhibit a...