Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate.
BACKGROUND
Estimated glomerular filtration rate (eGFR) before coronary artery bypass graft (CABG) surgery is a key risk factor of in-hospital mortality. However, in patients with normal renal function before CABG, acute kidney injury develops after the procedure, making postoperative renal function assessment necessary for evaluation. Postoperative eGFR and its association with long-term survival have not been well studied.


METHODS
We studied 13,593 consecutive CABG patients in northern New England from 2001 to 2006. Patients with preoperative dialysis were excluded. Data were linked to the Social Security Association Death Master File to assess long-term survival. Kaplan-Meier and log-rank techniques were used. Patients were stratified by established categories of postoperative eGFR (90 or greater, 60 to 89, 30 to 59, 15 to 29, and less than 15 mL x min(-1) x 1.73 m(-2)).


RESULTS
Median follow-up was 2.8 years (mean, 2.7; range, 0 to 5.5). Patients with moderate to severe acute kidney injury (less than 60) after CABG had significantly worse survival than patients with little or no acute kidney injury (90 or greater).


CONCLUSIONS
Patients having moderate to severe acute kidney injury after CABG surgery had worse 5-year survival compared with patients who had normal or near-normal renal function.
Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03756, USA. jeremiah.r.brown@dartmouth.edu
Jeremiah R
JR
Brown
Richard P
RP
Cochran
Todd A
TA
MacKenzie
Anthony P
AP
Furnary
Karyn S
KS
Kunzelman
Cathy S
CS
Ross
Craig W
CW
Langner
David C
DC
Charlesworth
Bruce J
BJ
Leavitt
Lawrence J
LJ
Dacey
Robert E
RE
Helm
John H
JH
Braxton
Robert A
RA
Clough
Robert F
RF
Dunton
Gerald T
GT
O'Connor
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors
D003404:Creatinine