Related Experiment Video
Updated: Dec 11, 2025
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Reassessment of kidney function equations in predicting long-term survival in cardiac surgery
Mélanie Hébert1, Gilles Amr1, Mariève Cossette2
1Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada.
Insights
The Cockcroft-Gault (CG) formula best predicts long-term survival after cardiac surgery compared to other equations. Postoperative estimated glomerular filtration rate (eGFR) at discharge also indicates survival outcomes.
Area of Science:
- Nephrology
- Cardiology
- Medical Statistics
Background:
- Chronic kidney disease (CKD) is a known risk factor for mortality in cardiac surgery patients.
- Several equations exist to estimate glomerular filtration rate (eGFR), including Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) study, CKD Epidemiology Collaboration (CKD-EPI), revised Lund-Malmö (LM), and full age spectrum (FAS).
Purpose of the Study:
- To compare the predictive accuracy of five different eGFR equations for long-term survival in patients undergoing cardiac surgery.
- To evaluate the prognostic value of both preoperative and postoperative eGFR estimates.
Main Methods:
- Prospective data from 1492 patients undergoing isolated off-pump coronary artery bypass surgery were analyzed.
- Preoperative and postoperative eGFR were calculated using CG, MDRD, CKD-EPI, LM, and FAS equations.
- Cox regression analyses and time-dependent receiver operating characteristic (ROC) curves at 10 years were used for comparison.
Main Results:
- The CG formula demonstrated the strongest predictive value for long-term mortality, with a lower adjusted hazard ratio (HR) for a one standard deviation increase in preoperative eGFR (0.661, P < .0001).
- The FAS equation also showed comparable prognostic value.
- Postoperative eGFR at discharge was a significant predictor of long-term survival across all tested equations.
Conclusions:
- The CG formula is recommended for better prediction of survival in cardiac surgery patients.
- The FAS equation offers comparable prognostic value.
- Assessing postoperative eGFR at discharge provides valuable information for predicting long-term survival.
Background/Objectives:
Chronic kidney disease (CKD) is a risk factor for long-term survival in cardiac surgery. The Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) study, CKD Epidemiology Collaboration (CKD-EPI), revised Lund-Malmö (LM), and full age spectrum equations are used to estimate glomerular filtration rates (eGFR), but each have advantages and disadvantages. Our objective was to determine which equation better predicts long-term survival.
Methods:
Data on 1492 consecutive patients who underwent isolated off-pump coronary artery bypass surgery between September 1996 and December 2008 were prospectively collected. Preoperative and postoperative eGFR were calculated using the five equations and compared using Cox regression analyses and time-dependent receiver operating characteristic (ROC) curves at 10 years.
Results:
In a Cox regression model after correction for significant predictors of long-term mortality, adjusted hazard ratios (HR) for one standard deviation increase in preoperative eGFR were 0.661 (P < .0001), 0.844 (P = .0166), 0.787 (P = .0002), 0.746 (P < .0001), and 0.717 (P < .0001) for the CG, MDRD, CKD-EPI, LM, and FAS equations, respectively. The areas under the time-dependent ROC curve at 10 years also showed that the CG formula has a better predictive value. Postoperative eGFR at discharge were also significant predictors of long-term mortality (HR = 0.603, P < .0001; HR = 0.725, P < .0001; HR = 0.688, P < .0001; HR = 0.673, P < .0001; HR = 0.632, P < .0001 for the CG, MDRD, CKD-EPI, LM, and FAS equations, respectively).
Conclusions:
The CG formula was shown to better predict survival in cardiac surgery, though the FAS equation has a comparable prognostic value. Additionally, postoperative eGFR at discharge also predicted long-term survival.
Related Concept Videos
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:25Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant
01:17Factors Affecting Renal Clearance: Renal Impairment
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...
01:29Acute Kidney Injury III: Clinical Manifestations