title: Impact of renal failure on in-hospital outcomes after coronary artery bypass surgery.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a predictor of increased mortality in patients undergoing coronary artery bypass surgery (CABG).
  
  
  OBJECTIVE
  To evaluate the characteristics and predictors of increased mortality in the CKD population submitted to CABG. To compare in-hospital outcomes between patients with and without CKD, and with and without development of acute renal failure (ARF).
  
  
  METHODS
  Retrospective analysis of a prospective database of all isolated CABG performed in a single public tertiary hospital from 1999 to 2007. CKD was considered when creatinine > 1.5 mg/dl. Clinical characteristics, mortality and post-operative complications were evaluated according to renal function.
  
  
  RESULTS
  Of 3,890 patients, 362 (9.3%) had CKD. This population was older, presented grater prevalence of hypertension, left ventricular dysfunction, previous stroke, peripheral vascular disease and three-vessel disease. In-hospital outcomes revealed greater incidence of stroke (5.5% vs 2.1%), atrial fibrillation (16 vs 8.3%), low cardiac ouput syndrome (14.4% vs 8.5%), longer stay in intensive care unit (4.04 vs 2.83 days), and greater mortality (10.5% vs 3.8%). Logistic regression: female gender, smoking, diabetes and peripheral vascular disease were associated with higher in-hospital mortality within the CKD group. Patients who did not develop post-operative ARF presented 3.5% mortality; non-dialytic ARF: 35.4%; dialytic ARF: 66.7% mortality. Mortality was directly related to the stage of CKD, according to glomerular filtration rate.
  
  
  CONCLUSIONS
  CKD patients submitted to CABG represent a high risk population, with increased incidence of complications and mortality. Post-operative ARF is a strong in-hospital mortality predictor. Glomerular filtration rate was inversely related to mortality.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil.
authors.forename: Roberto Ramos
authors.initials: RR
authors.lastname: Barbosa
authors.forename: Priscila Feitoza
authors.initials: PF
authors.lastname: Cestari
authors.forename: Julhano Tiago
authors.initials: JT
authors.lastname: Capeletti
authors.forename: Gustavo Magnus T L S R
authors.initials: GM
authors.lastname: Peres
authors.forename: Tania L Pozzo
authors.initials: TL
authors.lastname: Ibañez
authors.forename: Patrícia Viana
authors.initials: PV
authors.lastname: da Silva
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Farran
authors.forename: Vivian Lerner
authors.initials: VL
authors.lastname: Amato
authors.forename: Pedro Silvio
authors.initials: PS
authors.lastname: Farsky
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D001938:Brazil / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*