The impact of moderate-to-end-stage renal failure on outcomes after coronary artery bypass graft surgery.
OBJECTIVE
Currently, established renal failure is a well-recognized risk factor for operative mortality in patients undergoing coronary artery bypass graft (CABG) surgery. The authors aimed to establish the relative impact of dialysis-dependent renal failure (DRF) and nondialysis-dependent renal failure (NDRF) on early and late outcome after CABG surgery.


METHODS
A retrospective cohort study.


METHODS
A single teaching hospital.


METHODS
The authors analyzed prospectively collected data from 2,960 adult patients who underwent isolated CABG surgery between 1998 and 2006 at the authors' institution, according to whether they had preoperative NDRF based on preoperative creatinine >2.5 mg/dL, DRF, or neither (controls).


METHODS
CABG surgery.


RESULTS
Outcome measures included hospital mortality, postoperative complications, length of stay, and survival. Hospital mortality was 1.8% (n = 52). Patients in the NDRF and DRF groups had a significantly increased mortality (8.3%, n = 13) compared with the control group (1.4%, n = 39), and both NDRF (odds ratio [OR] = 6.2; 95% confidence interval, 2.3-16.5; p < 0.001) and DRF (OR = 4.0; 95% confidence interval, 1.6-10.0; p = 0.004) were found to be independent predictors of operative mortality. The overall mean follow-up was 3.9 +/- 2.5 years. Multivariate analysis revealed DRF (OR = 5.1) to be an independent predictor of late mortality after cardiac surgery, whereas NDRF was not found to be an independent predictor of late mortality.


CONCLUSIONS
Preoperative renal failure is an independent risk factor for adverse early and late outcomes after CABG surgery. NDRF is associated with increased hospital mortality and major morbidity compared with patients with lesser degrees of renal dysfunction, but also compared with DRF patients.
Chikwe
Joanna
J
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. joanna.chikwe@mountsinai.org
Castillo
Javier G
JG
Rahmanian
Parwis B
PB
Akujuo
Adanna
A
Adams
David H
DH
Filsoufi
Farzan
F
D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome