Impact of renal dysfunction on outcomes of coronary artery bypass surgery : Results from the society of thoracic surgeons national adult cardiac database

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-02, Vol.113 (8), p.1063-1070
• Main Authors: COOPER, William A, O'BRIEN, Sean M, THOURANI, Vinod H, GUYTON, Robert A, BRIDGES, Charles R, SZCZECH, Lynda A, PETERSEN, Rebecca, PETERSON, Eric D
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Disease - complications; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Coronary Disease - complications; Coronary Disease - surgery; Coronary heart disease; Databases, Factual; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Glomerular Filtration Rate; Heart; Humans; Kidney Diseases - complications; Kidney Diseases - diagnosis; Kidney Diseases - mortality; Medical sciences; Morbidity; Mortality; Postoperative Complications - etiology; Predictive Value of Tests; Prognosis; Regression Analysis; Risk Assessment; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.580084

Although patients with end-stage renal disease are known to be at high risk for mortality after coronary artery bypass graft (CABG) surgery, the impact of lesser degrees of renal impairment has not been well studied. The purpose of this study was to compare outcomes in patients undergoing CABG with a range from normal renal function to dependence on dialysis. We reviewed 483,914 patients receiving isolated CABG from July 2000 to December 2003, using the Society of Thoracic Surgeons National Adult Cardiac Database. Glomerular filtration rate (GFR) was estimated for patients with the use of the Modification of Diet in Renal Disease study formula. Multivariable logistic regression was used to determine the association of GFR with operative mortality and morbidities (stroke, reoperation, deep sternal infection, ventilation >48 hours, postoperative stay >2 weeks) after adjustment for 27 other known clinical risk factors. Preoperative renal dysfunction (RD) was common among CABG patients, with 51% having mild RD (GFR 60 to 90 mL/min per 1.73 m2, excludes dialysis), 24% moderate RD (GFR 30 to 59 mL/min per 1.73 m2, excludes dialysis), 2% severe RD (GFR