Impact of Preoperative Renal Dysfunction on Cardiac Surgery Results

• Published in: Asian cardiovascular & thoracic annals Vol. 11; no. 1; pp. 42 - 47
• Main Authors: Abramov, Dan, Tamariz, Miguel, Fremes, Stephen, Tobe, Sheldon, Christakis, George, Guru, Veena, Goldman, Bernard
• Format: Journal Article
• Language: English
• Published: London, England Asian Soc Cardio Surg 01-03-2003; SAGE Publications
• Subjects: Aged; Comorbidity; Coronary Artery Bypass - statistics & numerical data; Female; Heart Diseases - epidemiology; Heart Diseases - surgery; Heart Valve Prosthesis Implantation - statistics & numerical data; Humans; Logistic Models; Male; Middle Aged; Proportional Hazards Models; Renal Insufficiency - epidemiology; Renal Insufficiency - surgery; Treatment Outcome
• ISSN: 0218-4923; 1816-5370
• DOI: 10.1177/021849230301100111

Results of cardiac surgery were analyzed using a database that included plasma creatinine levels in 2,214 patients, of whom 507 had preoperative renal dysfunction (creatinine clearance < 0.9 mL·s−1·m−2). Logistic regression and propensity score analyses found preoperative renal dysfunction to be an independent predictor of morbidity and mortality. Plotting preoperative creatinine clearance against morbidity and mortality revealed an exponential increase in morbidity and mortality when preoperative creatinine clearance was < 0.84 mL·s−1·m−2. Patients were stratified for age, operative procedure, and comorbidity. In all stratified groups, preoperative creatinine clearance < 0.84 mL·s−1·m−2 was associated with similar exponential increases in morbidity and mortality. In patients with preoperative renal dysfunction, elevated plasma creatinine levels persevered for 6 months postoperatively. Dialysis beyond postoperative day 10 was required in < 2% of patients with preoperative plasma creatinine of 160–200 μmol·L−1 and in 5% in those with creatinine > 200 μmol·L−1 (p < 0.05). Actuarial survival was significantly reduced (< 90% at 18 months postoperatively) in patients with preoperative renal dysfunction.