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Association of Kidney Function With Inpatient Mortality and Morbidity After Cardiac Surgery
Vikram Fielding-Singh1, Matthew W Vanneman1, Tracey Hong1
1Division of Cardiovascular and Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
Insights
Advanced chronic kidney disease (CKD) is linked to more cardiac surgeries and higher in-hospital mortality rates. This study highlights the increased risks for CKD patients undergoing cardiac procedures.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Limited contemporary data exist on cardiac surgery rates and outcomes for patients with non-dialysis-requiring chronic kidney disease (CKD).
- Understanding the relationship between CKD stages and postoperative outcomes is crucial for patient care.
Purpose of the Study:
- To examine the incidence of cardiac surgical procedures across different stages of kidney disease.
- To evaluate the association between chronic kidney disease (CKD) stages and in-hospital mortality following cardiac surgery.
Main Methods:
- Analysis of adult hospital admissions for cardiac surgical procedures in the US (2010-2019).
- Kidney disease categorized as CKD stage G3, CKD stages G4/G5, and end-stage kidney disease (ESKD).
- Multivariable logistic regression used to assess the association between CKD stage and in-hospital mortality.
Main Results:
- An estimated 2,772,081 cardiac surgical procedures were identified.
- Incidence of procedures was higher in patients with CKD, particularly ESKD (13.0 per 1000 person-years).
- In-hospital mortality increased with CKD severity: 3.7% (CKD G3), 6.7% (CKD G4/G5), and 8.8% (ESKD) compared to 2.2% in normal kidney function.
Conclusions:
- Advanced CKD stages are associated with increased cardiac surgical procedure incidence in the US.
- Patients with CKD undergoing cardiac surgery face significantly higher adjusted risks of in-hospital mortality.
- These findings underscore the importance of risk stratification and management for CKD patients.
Background:
Contemporary population-based data examining the rates of cardiac surgery and the relationship between non-dialysis-requiring chronic kidney disease (CKD) and postoperative outcomes in cardiac surgery are limited.
Methods:
We identified hospital admissions for cardiac surgical procedures in adults from 2010-2019 in the United States. The primary exposure was kidney disease, categorized as CKD stage G3, CKD stages G4 or G5, and end-stage kidney disease (ESKD). The primary outcome was in-hospital mortality. We evaluated the association between CKD stage and in-hospital-mortality by using multivariable logistic regression. We calculated the annual national incidence of cardiac surgical procedures by CKD stage by incorporating data from the United States Census Bureau.
Results:
We identified an estimated 2,772,081 admissions during which patients aged 18 years or older underwent cardiac surgical procedures. The incidence of cardiac surgical procedures was 1.1, 1.0, and 13.0 per 1000 person-years among patients with normal or nearly normal kidney function, non-dialysis-requiring kidney disease, and ESKD, respectively. In-hospital mortality was 2.2%, 3.7%, 6.7%, and 8.8% among patients with normal or nearly normal kidney function, CKD stage G3, CKD stages G4 or G5, and ESKD, respectively. In adjusted analyses, patients with CKD stage G3, CKD stage G4 or G5, and ESKD experienced absolute risks of in-hospital mortality that were 0.6% (95% CI, 0.5%-0.7%), 2.2% (95% CI, 1.8%-2.6%), and 4.4% (95% CI, 4.0%-4.8%) higher, respectively, than in patients with normal or nearly normal kidney function.
Conclusions:
In the United States, advanced stages of CKD are associated with an increased incidence of cardiac surgical procedures, as well as high adjusted risks of in-hospital mortality.
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