title: Preoperative estimated glomerular filtration rate and the risk of major adverse cardiovascular and cerebrovascular events in non-cardiac surgery.
abstract: BACKGROUND
  Chronic kidney disease is an independent predictor of perioperative cardiovascular morbidity and mortality. We analysed the preoperative estimated glomerular filtration rate (eGFR) as a risk factor for perioperative major adverse cardiovascular and cerebrovascular events (MACCE) in non-cardiac surgery.
  
  
  METHODS
  In a post hoc analysis of the ANESCARDIOCAT database, patients were classified into six stages of eGFR calculated with the abbreviated Modification of Diet in Renal Disease Study and the Chronic Kidney Disease Epidemiology Collaboration equations: >90 (1), 60-89.9 (2), 45-59.9 (3a), 30-44.9 (3b), 15-29.9 (4), and <15 (5) ml min(-1) 1.73 m(-2). We analysed differences in MACCE, length of hospital stay, and all-cause mortality between eGFR stages.
  
  
  RESULTS
  The eGFR was available in 2323 patients. Perioperative MACCE occurred in 4.5% of patients and cardiac-related mortality was 0.5%. Five hundred and forty-three (23.4%) patients had an eGFR of <60 ml min(-1) 1.73 m(-2) and 127 (5.4%) had an eGFR below 45 ml min(-1) 1.73 m(-2). Logistic regression analysis showed that MACCE increased with eGFR impairment (P<0.001), with a marked increase from stage 3b onwards (odds ratio 1.8 vs 3.9 in 3a and 3b, respectively, P=0.047). All-cause mortality was not related to eGFR (P=0.071), but increased substantially between stages 3b and 4. The length of stay correlated with eGFR (P<0.001).
  
  
  CONCLUSIONS
  Perioperative MACCE increase with declining eGFR, primarily when <45 ml min(-1) 1.73 m(-2). We recommend the use of preoperative eGFR for cardiovascular risk assessment.
authors.affiliation: Department of Anaesthesiology, Parc de Salut Mar, Pg. Marítim 25-29, 08003 Barcelona, Spain amases@parcdesalutmar.cat.
authors.forename: A
authors.initials: A
authors.lastname: Mases
authors.affiliation: Department of Anaesthesiology and.
authors.forename: S
authors.initials: S
authors.lastname: Sabaté
authors.affiliation: Department of Anaesthesiology, Hospital de Sabadell, Sabadell, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Guilera
authors.affiliation: Department of Anaesthesiology, Parc de Salut Mar, Pg. Marítim 25-29, 08003 Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sadurní
authors.affiliation: Department of Anaesthesiology, Parc de Salut Mar, Pg. Marítim 25-29, 08003 Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Arroyo
authors.affiliation: Department of Anaesthesiology, Parc de Salut Mar, Pg. Marítim 25-29, 08003 Barcelona, Spain Department of Anaesthesiology, Vivantes Klinikum Hellersdorf, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Fau
authors.affiliation: Department of Anaesthesiology, Parc de Salut Mar, Pg. Marítim 25-29, 08003 Barcelona, Spain Department of Anaesthesiology, Centre Hospitalier Saint Palais, Sant Palais, France.
authors.forename: A
authors.initials: A
authors.lastname: Rojo
authors.affiliation: Department of Anaesthesiology, Parc de Salut Mar, Pg. Marítim 25-29, 08003 Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Castillo
authors.affiliation: Department of Nephrology, Fundació Puigvert (IUNA), Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bover
authors.affiliation: Department of Anaesthesiology and.
authors.forename: P
authors.initials: P
authors.lastname: Sierra
authors.affiliation: Department of Anaesthesiology, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Canet
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology*; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome
keywords: cardiovascular system/complications; glomerular filtration rate; perioperative complications; renal insufficiency, chronic; risk assessment