Coronary artery bypass grafting in patients with non-dialysis-dependent renal insufficiency
1Division of Cardiovascular Surgery, Sunnybrook Health Science Centre and The Toronto Hospital, Ontario, Canada.
Insights
Patients with mild renal insufficiency undergoing coronary artery bypass graft (CABG) surgery face higher risks. This includes increased need for blood transfusions, low output syndrome, and longer hospital stays, even without dialysis dependence.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Preoperative renal failure significantly elevates morbidity and mortality risks associated with coronary artery bypass graft (CABG) surgery.
- The impact of CABG on patients with mild, non-dialysis-dependent renal insufficiency remains largely uncharacterized.
Purpose of the Study:
- To investigate the outcomes of isolated CABG in patients with mild preoperative renal insufficiency compared to controls without this condition.
Main Methods:
- A cohort of 38 patients with preoperative renal insufficiency (serum creatinine >150 micromol/L) was identified from 2978 isolated CABG patients (1990-1996).
- These patients were matched to 152 control patients based on six prognostic variables.
- Patients requiring preoperative dialysis were excluded from the analysis.
Main Results:
- The renal insufficiency group had a higher prevalence of advanced age, diabetes, hypertension, peripheral vascular disease, and left ventricular dysfunction.
- Patients with renal insufficiency were more likely to require perioperative blood transfusions (P<.001) and postoperative dialysis (P<.01).
- Longer ventilation times, intensive care unit (ICU) stays, and postoperative hospital stays were observed in the renal insufficiency group. Mild renal insufficiency independently predicted postoperative low output syndrome (OR=3.6).
Conclusions:
- Mild renal insufficiency, independent of dialysis status, is associated with increased risks during CABG.
- These risks include a greater likelihood of blood transfusion, development of low output syndrome, and extended ICU and hospital stays post-surgery.
Background:
Preoperative renal failure increases the morbidity and mortality of coronary artery bypass graft (CABG) surgery. The results of CABG in patients with non-dialysis-dependent, mild renal insufficiency are unknown.
Methods:
From a population of 2978 consecutive patients undergoing isolated CABG from 1990 to 1996, 38 patients with preoperative renal insufficiency (Renal group; serum creatinine >150 micromol/L) were identified and matched on six prognostic variables to a cohort of 152 control patients (Control group). Two patients with preoperative dialysis-dependent renal failure were excluded from analysis.
Results:
Compared to the overall population, the Renal group were more likely to be over age 70, diabetic, hypertensive, and suffer from peripheral vascular disease and left ventricular dysfunction. Compared to the Control group, the Renal group were more likely to require perioperative blood transfusions (P<.001) and had a greater requirement for postoperative dialysis (P<.01). The Renal group had longer ventilation times, intensive care unit stay, and postoperative hospital stay. Mild renal insufficiency was found to be an independent predictor of postoperative low output syndrome (odds ratio=3.6).
Conclusions:
Mild renal insufficiency, even in the absence of dialysis, increases the risk of blood transfusion, low output syndrome and prolonged the length of intensive care unit and postoperative stay for patients undergoing CABG.
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