title: ARF after open-heart surgery: Influence of gender and race.
abstract: BACKGROUND
  Both acute renal failure (ARF) and female sex are strongly associated with mortality after open-heart surgery. This study analyzes the effect of sex and race on the incidence of ARF after open-heart surgery and its influence on mortality.
  
  
  METHODS
  A total of 24,660 patients underwent open-heart surgery at the Cleveland Clinic Foundation (Cleveland, OH) from 1993 to 2000. The primary outcome was ARF defined as ARF requiring dialysis, 50% or greater decline in glomerular filtration rate (GFR) not requiring dialysis, or 50% or greater decline in GFR relative to baseline or requirement of dialysis. The secondary outcome was all-cause hospital mortality.
  
  
  RESULTS
  The overall frequency of ARF requiring dialysis after open-heart surgery was 1.82%. The frequency was greater in women (2.36%) than men (1.60%; P < 0.0001) and blacks (2.94%) than nonblacks (1.70%; P < 0.0001) by univariate analysis. By multivariate analysis, risk for ARF requiring dialysis in women was 1.61 (confidence interval [CI], 1.27 to 2.05; P < 0.0001), but race was not a risk factor. The overall postoperative mortality rate was 2.2%, and for patients with ARF requiring dialysis, it was 61.2% (women, 68.6% versus men, 56.5%; P = 0.01) with an odds ratio of 49.29, whereas in patients with ARF not requiring dialysis, it was 14.1% (women, 13.3% versus men 14.6%; P = 0.63) with an odds ratio of 7.18.
  
  
  CONCLUSIONS
  Female sex is an independent risk factor for developing ARF after open-heart surgery. The influence of race on risk for ARF is less clear. Regardless of its definition, ARF is strikingly associated with a high risk for mortality.
authors.affiliation: Department of Nephrology and Hypertension, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Charuhas V
authors.initials: CV
authors.lastname: Thakar
authors.forename: Orfeas
authors.initials: O
authors.lastname: Liangos
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Yared
authors.forename: David
authors.initials: D
authors.lastname: Nelson
authors.forename: Marion R
authors.initials: MR
authors.lastname: Piedmonte
authors.forename: Srinivas
authors.initials: S
authors.lastname: Hariachar
authors.forename: Emil P
authors.initials: EP
authors.lastname: Paganini
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D000368:Aged; D044383:Black People; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D015897:Comorbidity; D004198:Disease Susceptibility; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D044469:Racial Groups; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors; D044465:White People