title: Outcome of coronary artery bypass operations in patients with renal insufficiency with and without renal transplantation.
abstract: OBJECTIVE
  Renal insufficiency (RI) is associated with an increased risk of morbidity and mortality following coronary artery bypass graft (CABG) operations, particularly among patients who are dependent on dialysis.
  
  
  METHODS
  A retrospective analysis of data collected at a tertiary care center.
  
  
  METHODS
  One hundred eighty-four consecutive patients with RI who underwent CABG surgery between 1992 and 2004. This group consisted of 152 patients with serum creatinine levels of > or = 1.7 mg/dL (group I) and 32 kidney transplant recipients (group II). Of the patients in group I, 90 were dialysis-free (subgroup IA) and 62 were dialysis-dependent (subgroup IB).
  
  
  METHODS
  Demographics, perioperative data, and outcomes for each of the three groups were evaluated and compared.
  
  
  RESULTS
  Fifty-four percent of the patients were in New York Heart Association classes III and IV, 36% had unstable angina, and 21% had left main coronary disease. The mean ejection fraction was 38%. The median postoperative length of stay in the hospital was 10 days. Of the patients in group IB, 8% required reexploration for bleeding compared to 3% in groups IA and II (p < 0.05). Dialysis was needed postoperatively in five patients in group IA and two patients in group II (5.7%). The raw operative mortality rate was 7.6% and was higher in group IB (9.7%) compared to groups IA and II (6.7% and 6.2%, respectively; p < 0.05). The actuarial 5-year survival rate was higher in group II compared to group I (79% vs 59%, respectively; p < 0.05). The difference in survival rates was more apparent between groups II and IB (79% vs 57%, respectively; p < 0.005).
  
  
  CONCLUSIONS
  CABG is associated with an increased rate of perioperative complications and mortality in patients with RI. Dialysis dependence is a major risk factor for patients undergoing CABG surgery. However, with acceptable surgical results, dialysis patients should not be denied CABG surgery. A survival advantage is demonstrated among patients with previous kidney transplants compared to those patients who are dependent on dialysis.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, 840 S Wood St, CSB Suite 417 (MC 958), Chicago, IL 60612, USA. mmassad@uic.edu
authors.forename: Malek G
authors.initials: MG
authors.lastname: Massad
authors.forename: Jacques
authors.initials: J
authors.lastname: Kpodonu
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.forename: Joseph
authors.initials: J
authors.lastname: Espat
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gandhi
authors.forename: Amul
authors.initials: A
authors.lastname: Tevar
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Geha
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome