The association between preoperative eGFR and outcomes in cardiac surgical patients.
OBJECTIVE
To study the relationship between preoperative renal function and outcomes in patients undergoing cardiac surgery.


METHODS
A retrospective descriptive study was performed on all patients who had coronary artery bypass, cardiac valve surgery and/or aortic arch surgery at a tertiary-referral hospital between January 2002 and December 2007.


METHODS
Clinical and demographic variables were compared across renal dysfunction categories, defined by glomerular filtration rate (eGFR) calculated using the modified Modification of Diet in Renal Disease (MDRD) equation. Logistic regression was used to assess the association between eGFR and outcomes, primarily in-hospital mortality.


RESULTS
7440 patients were included, with a mean age of 64 years and overall mortality of 1.6%. Across worsening renal function states, excluding patients receiving dialysis, patients were older, more likely to be women and to have comorbidities (particularly diabetes and vascular disease), as well as ventricular dysfunction, and to require emergency or more complex surgery. Unadjusted outcomes, as well as univariate and multivariate analysis, consistently demonstrated that odds ratios for adverse events increased with worsening renal function, even at moderate levels of dysfunction.


CONCLUSIONS
Preoperative renal dysfunction is independently associated with mortality after cardiac surgery. This is consistent with the accumulating evidence supporting preoperative renal dysfunction as a powerful predictor of adverse outcomes.
Foot
Carole L
CL
Critical Care Research Group, Departments of Intensive Care and Cardiac Surgery, Prince Charles Hospital, Brisbane, QLD.
Chinthamuneedi
Meher
M
Fraser
John F
JF
Smith
Susan E
SE
Fayers
Trevor
T
Tesar
Peter
P
Mullany
Daniel V
DV
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003325:Coronary Care Units; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends