title: Trends in cardiac surgery-associated acute renal failure in the United States: a disproportionate increase after heart transplantation.
abstract: Acute renal failure (ARF) is common after cardiac surgery and more frequent after complex cardiac surgery. While the incidence of ARF is increasing after coronary artery bypass graft (CABG) surgery, trends in other forms of cardiac surgery remain unclear. We investigated the trend of ARF in various cardiac procedures and compared patterns using CABG surgery as a reference group. The study population consisted of discharges from the Nationwide Inpatient Sample from 1988 to 2003, grouped according to surgery as: CABG, CABG with mitral valve, CABG with other valve, valve alone, and heart transplant. Standard diagnostic codes were used to identify ARF among discharges. Multivariable regression was used to determine trends in ARF among various procedures with CABG as a reference group. The incidence of ARF increased in all five groups (p < 0.001) over the 16-year period. The ARF incidence was highest in the heart transplant group (17%). Compared to the CABG population, patients following heart transplantation developed ARF at higher rates during the study period. In contrast, while ARF increased over time in other groups, the rates of rise were slower than in CABG patients. Among heart surgery procedures, ARF incidence is highest in heart transplantation. The incidence of ARF is also increasing at a faster rate in this group of patients in contrast to other procedure groups when compared to CABG surgery. The disproportionate increase in ARF burden after heart transplantation is a concern due to its strong association with chronic kidney disease and mortality.
authors.affiliation: Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Martinelli
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Phillips-Bute
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
authors.forename: Laura E
authors.initials: LE
authors.lastname: Archer
authors.forename: Mark
authors.initials: M
authors.lastname: Stafford-Smith
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shaw
authors.forename: Madhav
authors.initials: M
authors.lastname: Swaminathan
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology