Preoperative renal function as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population.
OBJECTIVE
Preoperative renal dysfunction is an established risk factor for early and late mortality after revascularization. We studied how renal function affects long-term survival of patients after coronary artery bypass grafting.


METHODS
Early and late mortality were determined retrospectively among consecutive patients having isolated coronary bypass at a single Dutch institution between January 1998 and December 2007. Patients were stratified into 4 groups according to preoperative renal function. Expected survival was gauged using a general Dutch population group that was obtained from the database of the Dutch Central Bureau for Statistics; for each of our renal function groups, a general population group was assembled by matching for age, gender, and year of operation.


RESULTS
After excluding 122 patients lost to follow-up, 10,626 patients were studied; in 10,359, preoperative creatinine clearance could be calculated. Multivariate logistic regression and Cox regression analysis identified renal dysfunction as a predictor for early and late mortality. When long-term survival of patient groups was compared with expected survival, only patients with a creatinine clearance less than 30 mL x min(-1) showed a worse outcome. Patients with a creatinine clearance between 60 and 90 mL x min(-1) had a long-term survival exceeding the expected survival.


CONCLUSIONS
Severity of renal dysfunction was related to poor survival. When compared with expected survival, however, patients having coronary bypass had a worse outcome only when severe preoperative renal dysfunction was present.
van Straten
Albert H M
AH
Department of Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Soliman Hamad
Mohamed A
MA
van Zundert
André A J
AA
Martens
Elisabeth J
EJ
Schönberger
Jacques P A M
JP
de Wolf
Andre M
AM
D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate
D003404:Creatinine