title: Impact of preoperative renal dysfunction on outcomes of off-pump coronary artery bypass grafting.
abstract: BACKGROUND
  This study assessed whether preoperative renal insufficiency predisposes patients undergoing off-pump coronary artery revascularization to postoperative dialysis.
  
  
  METHODS
  From August 2004 through June 2009, 2,275 patients undergoing off-pump coronary artery bypass were categorized into five groups (stages) by glomerular filtration rate (GFR). Of these, 1,855 patients had renal insufficiency: stage 2: 1,406; stage 3: 428; stage 4: 21, and 414 had normal renal function, stage 1. Excluded were 6 patients with end-stage renal disease (stage 5). Preoperative variables and postoperative outcomes were compared among groups.
  
  
  RESULTS
  Preoperative patient characteristics were similar; however, patients with normal renal function were younger (p = 0.001). Serum creatinine rose significantly above baseline on the first postoperative day in the renal insufficiency groups (p = 0.001). The GFR groups had similar inotrope use, reexploration rate, duration of postoperative mechanical ventilation, postoperative stroke, wound infection, and mortality rate. Stage 4 patients had a higher incidence of postoperative myocardial infarction (p = 0.002). Stage 3 and 4 patients had an increased need for postoperative dialysis vs stage 1 patients (p = 0.002).
  
  
  CONCLUSIONS
  Nonparametric contingency analysis showed patients with low preoperative GFR (stage 3 and 4, p < 0.0001) and a history of smoking (p = 0.04) were at increased risk for postoperative dialysis. Patients who required postoperative inotropic support tended toward requiring postoperative dialysis (p = 0.06). Low preoperative ejection fraction (p = 0.83), class III or IV angina (p = 0.069), and postoperative blood transfusions were not associated with the need for postoperative dialysis in patients undergoing off-pump revascularization.
authors.affiliation: Division of Cardiothoracic Surgery, Star Hospitals, Banjara Hills, Hyderabad, India. sajjalr@yahoo.com
authors.forename: Lokeswara Rao
authors.initials: LR
authors.lastname: Sajja
authors.forename: Gopichand
authors.initials: G
authors.lastname: Mannam
authors.forename: Rajasekara M
authors.initials: RM
authors.lastname: Chakravarthi
authors.forename: Jyothsna
authors.initials: J
authors.lastname: Guttikonda
authors.forename: Sriramulu
authors.initials: S
authors.lastname: Sompalli
authors.forename: Joshua
authors.initials: J
authors.lastname: Bloomstone
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications*; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome