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Hidden renal dysfunction causes increased in-hospital mortality risk after coronary artery bypass graft surgery

Mathias Alexandre Volkmann1, Paulo Eduardo Ballvé Behr, Jayme Eduardo Burmeister

  • 1Universidade Luterana do Brasil, Canoas, RS, Brasil.

Revista Brasileira De Cirurgia Cardiovascular : Orgao Oficial Da Sociedade Brasileira De Cirurgia Cardiovascular
|November 17, 2011
PubMed

Insights

Patients undergoing cardiac surgery with normal serum creatinine may still have impaired kidney function. This subgroup faces double the mortality risk and longer hospital stays, highlighting the need for better renal assessment.

Area of Science:

  • Nephrology
  • Cardiology
  • Surgical Outcomes

Background:

  • Preoperative chronic kidney dysfunction is a significant predictor of mortality in cardiac surgery patients.
  • Serum creatinine levels within the normal range do not always reflect normal renal function.
  • Assessing renal function beyond serum creatinine is crucial for accurate risk stratification.

Purpose of the Study:

  • To compare mortality rates, total hospital stay, and post-surgical hospital stay in cardiac surgery patients with normal serum creatinine but varying levels of estimated creatinine clearance.
  • To identify patients with potentially undetected renal dysfunction despite normal serum creatinine levels.
  • To evaluate the impact of impaired renal function, defined by creatinine clearance, on outcomes after coronary artery bypass surgery.

Main Methods:

  • Utilized data from 4,765 patients undergoing coronary artery bypass surgery (January 1996 - June 2004).
  • Estimated creatinine clearance using the Cockroft-Gault equation.
  • Defined impaired renal function as creatinine clearance <60 mL/min/1.73 m² (National Kidney Foundation-USA chronic kidney disease stage 3).
  • Compared in-hospital mortality, total hospital stay, and post-surgical hospital stay between groups.

Main Results:

  • Analyzed data from 4,688 patients; 4,403 had serum creatinine < 1.5 mg/dL.
  • Within the normal serum creatinine group, 1,226 patients (Group B) had creatinine clearance <60 mL/min, compared to 3,177 (Group A) with clearance >60 mL/min.
  • Group B patients experienced significantly longer total hospital stays (2.85 days more) and post-surgical stays (1.79 days more) (P < 0.0001).
  • Group B had a 2.09 times higher relative risk of in-hospital death (95% CI: 1.54-2.84) compared to Group A.

Conclusions:

  • Over 25% of patients with serum creatinine < 1.5 mg/dL exhibited creatinine clearance <60 mL/min.
  • This significant proportion of patients with undetected renal dysfunction faced double the mortality risk.
  • These findings underscore the inadequacy of serum creatinine alone for assessing renal function in cardiac surgery candidates and highlight the importance of estimated creatinine clearance for predicting outcomes.
Abstract

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