title: Preoperative chronic kidney disease as a strong predictor of postoperative infection and mortality after coronary artery bypass grafting.
abstract: BACKGROUND
  The aim of this study was to determine the influence of preoperative kidney dysfunction (ie, chronic kidney disease (CKD)) on postoperative cardiovascular events, infection, acute kidney injury and hospital mortality in patients undergoing coronary artery bypass grafting (CABG). METHODS AND RESULTS: A multi-institutional retrospective study was performed at 14 hospitals of adult patients undergoing isolated CABG from 2007 to 2008 (n=1,522). We classified CKD level according to preoperative estimated glomerular filtration rate (eGFR): normal, eGFR >90 ml·min(-1)·1.73 m(-2); mild, eGFR 60-90 ml·min(-1)·1.73 m(-2); moderate, eGFR 30-59 ml·min(-1)·1.73 m(-2); and severe, eGFR <30 ml·min(-1)·1.73 m(-2), and assessed postoperative outcome. Preoperative CKD distribution was as follows: normal, n=121 (8%); mild, n=713 (47%); moderate, n=515 (34%); and severe, n=169 (11%). Risk of infection was strongly correlated with CKD level (normal, 3.3%; mild, 7.0%; moderate, 8.3%; severe, 17.0%; P<0.01). The risk of in-hospital death was also strongly correlated with CKD level (normal, 1.7%; mild, 1.0%; moderate, 1.6%; severe, 5.9%; P<0.01). On multivariate logistic regression analysis, CKD level was identified as a significant risk factor for postoperative infection, acute kidney injury, and in-hospital death.
  
  
  CONCLUSIONS
  Advanced preoperative CKD is a strong predictor of postoperative infection, acute kidney injury and in-hospital death after CABG.
authors: Kyoto University Graduate School of Medicine.
authors: Kenji
authors: K
authors: Minakata
authors: Ko
authors: K
authors: Bando
authors: Shiro
authors: S
authors: Tanaka
authors: Shuichiro
authors: S
authors: Takanashi
authors: Hiroaki
authors: H
authors: Konishi
authors: Yoshihiro
authors: Y
authors: Miyamoto
authors: Kenji
authors: K
authors: Ueshima
authors: Shinji
authors: S
authors: Yasuno
authors: Yuichi
authors: Y
authors: Ueda
authors: Yutaka
authors: Y
authors: Okita
authors: Izuru
authors: I
authors: Masuda
authors: Hitoshi
authors: H
authors: Okabayashi
authors: Hitoshi
authors: H
authors: Yaku
authors: Yoshitaka
authors: Y
authors: Okamura
authors: Kazuo
authors: K
authors: Tanemoto
authors: Koichi
authors: K
authors: Arinaga
authors: Yosuke
authors: Y
authors: Hisashi
authors: Ryuzo
authors: R
authors: Sakata
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000601:surgery; D012307:Risk Factors