title: Improving the identification of patients at risk of postoperative renal failure after cardiac surgery.
abstract: BACKGROUND
  Preoperative renal insufficiency is an important predictor of the need for postoperative renal replacement therapy (RRT). Serum creatinine (sCr) has a limited ability to identify patients with preoperative renal insufficiency because it varies with age, sex, and muscle mass. Calculated creatinine clearance (CrCl) is an alternative measure of renal function that may allow better estimation of renal reserve.
  
  
  METHODS
  Data were prospectively collected for consecutive patients who underwent cardiac surgery requiring cardiopulmonary bypass at a tertiary care center. The relation between CrCl (Cockcroft-Gault equation) and RRT was initially described using descriptive statistics, logistic regression, and receiver operating curve analysis. Based on these analyses, preoperative renal insufficiency was defined as CrCl of 60 ml/min or less. Preoperative renal function was classified as moderate insufficiency (sCr > 133 microM), mild insufficiency (100 microM < sCr < or = 133 microM), occult insufficiency (sCr < or = 100 microM and CrCl < or = 60 ml/min), or normal function (sCr < or = 100 microM and CrCl > 60 ml/min). The independent association of preoperative renal function with RRT was subsequently determined using multiple logistic regression.
  
  
  RESULTS
  Of the 10,751 patients in the sample, 137 (1.2%) required postoperative RRT. Approximately 13% of patients with normal sCr had occult renal insufficiency. Occult renal insufficiency was independently associated with RRT (odds ratio, 2.80; 95% confidence interval, 1.39-5.33). The magnitude of this risk was similar to patients with mild renal insufficiency (P = 0.73).
  
  
  CONCLUSIONS
  The inclusion of a simple CrCl-based criterion in preoperative assessments may improve identification of patients at risk of needing postoperative RRT.
authors.affiliation: Department of Anesthesia, Toronto General Hospital and University of Toronto, Ontario, Canada. duminda.wijeysundera@uhn.on.ca
authors.forename: Duminda N
authors.initials: DN
authors.lastname: Wijeysundera
authors.forename: Keyvan
authors.initials: K
authors.lastname: Karkouti
authors.forename: W Scott
authors.initials: WS
authors.lastname: Beattie
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology; D000368:Aged; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000097:blood; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D003404:Creatinine