title: Preoperative proteinuria is associated with long-term progression to chronic dialysis and mortality after coronary artery bypass grafting surgery.
abstract: OBJECTIVE
  Preoperative proteinuria is associated with post-operative acute kidney injury (AKI), but whether it is also associated with increased long-term mortality and end-stage renal disease (ESRD) is unknown.
  
  
  RESULTS
  We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+) or heavy (2+ to 4+) according to the results of the dipstick test. A total of 276 (29.8%) patients had mild proteinuria before surgery and 119 (12.9%) patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17) was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88) and heavy proteinuria ([HR], 2.28) to predict all-cause mortality compared to no proteinuria. Mild ([HR], 2.57) and heavy proteinuria ([HR], 2.70) exhibited a stepwise increased ratio compared to patients without proteinuria for long-term composite catastrophic outcomes (mortality and ESRD), which were independent of the baseline GFR and postoperative acute kidney injury (AKI).
  
  
  CONCLUSIONS
  Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Tao-Min
authors.initials: TM
authors.lastname: Huang
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Wu
authors.forename: Wei-Jie
authors.initials: WJ
authors.lastname: Wang
authors.forename: Chia-Ter
authors.initials: CT
authors.lastname: Chao
authors.forename: Shao-Yu
authors.initials: SY
authors.lastname: Yang
authors.forename: Chih-Chung
authors.initials: CC
authors.lastname: Shiao
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Hu
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: Yin-Yi
authors.initials: YY
authors.lastname: Han
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
authors.forename: Ron-Bin
authors.initials: RB
authors.lastname: Hsu
authors.forename: Guang-Huar
authors.initials: GH
authors.lastname: Young
authors.forename: Shoei-Shen
authors.initials: SS
authors.lastname: Wang
authors.forename: Pi-Ru
authors.initials: PR
authors.lastname: Tsai
authors.forename: Yung-Ming
authors.initials: YM
authors.lastname: Chen
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Chao
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D000328:Adult; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D057234:Preoperative Period; D011446:Prospective Studies; D011507:Proteinuria / Q000150:complications*; D006435:Renal Dialysis; D055815:Young Adult