title: The impact of renal artery stenosis on outcomes after open-heart surgery.
abstract: OBJECTIVE
  The aim of this study was to assess the impact of atherosclerotic renal artery stenosis (ARAS) on outcomes after open-heart surgery (OHS).
  
  
  BACKGROUND
  Acute kidney injury after OHS portends significant morbidity and mortality.
  
  
  METHODS
  Data from all adult patients undergoing OHS from January 2000 to April 2010 who underwent renal duplex ultrasound were prospectively collected. ARAS was severe (60% to 99% stenosis) if peak systolic velocity was >200 cm/s. The associations between ARAS and post-operative reduction in glomerular filtration rate (GFR), need for renal replacement therapy, length of stay, and overall short-term and long-term mortality (up to 8 years) were tested using multivariate time-to-event adjusted analysis.
  
  
  RESULTS
  A total of 714 patients were evaluated, with a mean age of 67 ± 12 years (63% men) and a mean GFR of 52 ± 25.9 ml/min/1.73 m(2). A total of 206 (29%) had ARAS; of these, 79% (n = 163) had unilateral and 21% (n = 43) had bilateral ARAS. ARAS was associated with peripheral artery disease (p = 0.004) and lower high-density lipoprotein levels (p = 0.04). Patients with advanced age (p = 0.01) and descending aorta grafting (p = 0.004) had significant post-operative reductions in GFR. Adjusted models showed a nonsignificant trend between ARAS and reduction in GFR (p = 0.09). ARAS was not associated with need for renal replacement therapy (p = 0.4), longer length of stay (p = 0.7), or mortality (p = 0.7), but low pre-operative GFR was a strong predictor of long-term mortality.
  
  
  CONCLUSIONS
  ARAS does not appear to be associated with post-operative change in GFR, need for hemodialysis, longer length of stay, or mortality in patients undergoing OHS.
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Femi
authors.initials: F
authors.lastname: Philip
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
authors.affiliation: Department of Quantitative Health Sciences, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: shishem@ccf.org.
authors.forename: Mehdi H
authors.initials: MH
authors.lastname: Shishehbor
mesh_terms: D000367:Age Factors; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D050197:Atherosclerosis / Q000150:complications; D001026:Coronary Artery Bypass; D005260:Female; D005919:Glomerular Filtration Rate; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D011183:Postoperative Complications; D011446:Prospective Studies; D012042:Registries; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006435:Renal Dialysis; D012737:Sex Factors; D014463:Ultrasonography
chemical_list: D008075:Lipoproteins, HDL
keywords: AKI; ARAS; GFR; OHS; PSV; RAR; RFA; RRT; acute kidney injury; atherosclerotic renal artery disease; atherosclerotic renal artery stenosis; glomerular filtration rate; hemodialysis; mortality; open-heart surgery; peak systolic velocity; random forest analysis; renal dysfunction; renal replacement therapy; renal/aortic resistive index