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Preoperative hidden renal dysfunction add an age dependent risk of progressive chronic kidney disease after cardiac
Jiarui Xu1,2,3,4, Jiawei Yu1,2,3,4, Xialian Xu1,2,3,4
1Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
Insights
Hidden renal dysfunction, a condition with normal serum creatinine, is common in cardiac surgery patients. It is a risk factor for progressive chronic kidney disease in patients under 65.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Normal serum creatinine does not exclude renal dysfunction in cardiac surgery patients.
- Assessing estimated glomerular filtration rate (eGFR) is crucial for identifying hidden renal dysfunction.
- Hidden renal dysfunction may impact cardiac surgery outcomes.
Purpose of the Study:
- To investigate the prevalence of hidden renal dysfunction in cardiac surgery patients with normal serum creatinine.
- To determine if different levels of eGFR are risk factors for hidden renal function and cardiac surgery outcomes.
- To analyze the association between renal dysfunction and postoperative acute kidney injury, chronic kidney disease progression, and mortality.
Main Methods:
- A cohort of 1744 cardiac surgery patients with normal serum creatinine was divided into three groups based on eGFR: ≥90 mL/min/1.73 m² (no renal dysfunction), 60–89 mL/min/1.73 m² (hidden renal dysfunction), and <60 mL/min/1.73 m² (known renal dysfunction).
- Patients were followed up for 3 years.
- Multivariate regression analyses were used to identify risk factors for postoperative acute kidney injury.
Main Results:
- Hidden renal dysfunction was prevalent in 49.1% of patients with normal serum creatinine.
- The prevalence of preoperative hidden renal dysfunction was higher in patients ≥65 years (67.1%) compared to those <65 years (44.1%).
- In patients <65 years, known renal dysfunction was a risk factor for postoperative acute kidney injury and progressive chronic kidney disease, while hidden renal dysfunction was a risk factor for progressive chronic kidney disease.
- In patients ≥65 years, known renal dysfunction was a risk factor for 3-year mortality and progressive chronic kidney disease.
Conclusions:
- Hidden renal dysfunction is common among cardiac surgery patients with normal serum creatinine.
- In patients under 65, hidden renal dysfunction is an independent risk factor for the progression of chronic kidney disease.
- Age influences the impact of renal dysfunction on cardiac surgery outcomes, with older patients facing higher risks of mortality and CKD progression.
Background:
To study different value of estimated glomerular filtration rate with normal serum creatinine whether is a risk factor for hidden renal function of cardiac surgery outcomes.
Methods:
A total of 1744 cardiac surgery patients with serum creatinine ≤1.2 mg/dL (female)/1.5 mg/dL (male) were divided into 3 groups: estimated glomerular filtration rate ≥ 90 mL/min/1.73 m2 (no renal dysfunction, n = 829), 60 ≤ estimated glomerular filtration rate < 90 mL/min/1.73 m2 (hidden renal dysfunction, n = 857), estimated glomerular filtration rate < 60 mL/min/1.73 m2 (known renal dysfunction, n = 58) and followed up for 3 years. Multivariate regression analyses for risk factors of postoperative acute kidney injury.
Results:
The proportion of preoperative hidden renal dysfunction was 67.1% among patients ≥ 65 years old and 44.1% among patients < 65 years old. Multivariate Cox regression analyses showed that for patients < 65 years, known renal dysfunction was a risk factor for postoperative acute kidney injury (P < 0.01) and progressive chronic kidney disease (P = 0.018), while hidden renal dysfunction was a risk factor for progressive chronic kidney disease (P = 0.024). For patients ≥ 65 years, only known renal dysfunction was a risk factors for 3-year mortality (P = 0.022) and progressive chronic kidney disease (P < 0.01).
Conclusion:
Hidden renal dysfunction was common in patients with normal serum creatinine for cardiac surgery, with a prevalence of 49.1%. For patients < 65 years old, hidden renal dysfunction was an independent risk factor for progressive chronic kidney disease.
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