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Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery
Eduesley Santana-Santos1, Felipe Kenji Oshiro Kamei1, Tarcísia Karoline do Nascimento1
1Nursing Department, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
Insights
Patients with chronic kidney disease (CKD) who develop acute kidney injury (AKI) after coronary artery bypass graft surgery show good long-term renal and non-renal prognoses if they survive the initial hospitalization.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a frequent complication following cardiac surgery.
- Long-term outcomes for patients with pre-existing chronic kidney disease (CKD) who experience AKI are not well understood.
Purpose of the Study:
- To investigate the long-term prognosis of CKD patients who developed AKI after coronary artery bypass graft (CABG) surgery.
- To compare outcomes between CKD patients with and without AKI post-CABG.
Main Methods:
- A cohort of 58 CKD patients who underwent CABG were followed for approximately 48 months.
- Patients were divided into two groups: those who developed AKI (n=23) and those who did not (n=35).
- Secondary prevention strategies were employed for all participants.
Main Results:
- Overall survival was comparable between the AKI+ and AKI- groups, with 6 deaths (4 in AKI+, 2 in AKI-).
- Renal function remained similar between groups at follow-up; only one AKI- patient required dialysis.
- A small number of patients (4) experienced a significant increase in serum creatinine during the follow-up period.
Conclusions:
- CKD patients who survive the perioperative period after developing AKI during CABG surgery demonstrate favorable long-term renal and non-renal prognoses.
- The findings suggest that AKI in this specific patient population may not portend worse long-term outcomes compared to those without AKI.
Abstract:
Background. Acute kidney injury (AKI) is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD), are not known. Methods. We compared the long-term prognoses of CKD patients who developed (n = 23) and did not develop (n = 35) AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG). Fifty-eight patients who survived (69.6 ± 8.4 years old, 72% males, 83% Whites, 52% diabetics, baseline GFR: 46 ± 16 mL/min) were followed up for 47.8 ± 16.4 months and treated for secondary prevention of events. Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI- group (Log-rank = 0.218), two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI- patient was started on dialysis. Only 4 patients had an increase in serum creatinine ≥ 0.5 mg/dL during follow-up. Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.
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