title: Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) and is associated with adverse outcomes. However, the relationship between AKI after CABG and the long-term risk of end-stage renal disease (ESRD) is unknown.
  
  
  RESULTS
  This study included 29 330 patients who underwent primary isolated CABG in Sweden between 2000 and 2008. AKI was classified according to the Acute Kidney Injury Network (AKIN) classification: stage 1, >0.3 mg/dL (>26 μmol/L) or 50% to 100% increase; stage 2, 100% to 200% increase; and stage 3, >200% increase from the preoperative to postoperative serum creatinine level. Cox proportional hazards regression analysis was used to calculate hazard ratios with 95% confidence intervals for ESRD in AKIN stage 1 and stage 2 to 3. Postoperative AKI occurred in 13% of patients. During a mean follow-up of 4.3±2.4 years, 123 patients (0.4%) developed ESRD, including 50 (1.6%) in AKIN stage 1, 29 (5.2%) in AKIN stage 2 to 3, and 44 (0.2%) without AKI after CABG. After multivariable adjustment, the hazard ratio for ESRD was 2.92 (95% confidence interval, 1.87-4.55) for AKIN stage 1 and 3.81 (95% confidence interval, 2.14-6.79) for AKIN stage 2 to 3.
  
  
  CONCLUSIONS
  This nationwide study of patients who underwent CABG found that a small increase in the postoperative serum creatinine level was associated with an almost 3-fold increase in the long-term risk of ESRD after adjustment for a number of confounders, including preoperative renal function.
authors.affiliation: From the Department of Anaesthesiology, Surgical Services, and Intensive Care Medicine (L.R.), Department of Cardiothoracic Surgery and Anaesthesiology (U.S.), Department of Nephrology (M.E.), and Department of Emergency Medicine (M.J.H.), Karolinska University Hospital, Stockholm, Sweden; Swedish Renal Registry (M.E.), Jönköping, Sweden; and Department of Molecular Medicine and Surgery (U.S.), CLINTEC (M.E.), and Department of Internal Medicine (L.R., M.J.H.), Karolinska Institutet, Stockholm, Sweden. linda.ryden@karolinska.se.
authors.forename: Linda
authors.initials: L
authors.lastname: Rydén
authors.affiliation: From the Department of Anaesthesiology, Surgical Services, and Intensive Care Medicine (L.R.), Department of Cardiothoracic Surgery and Anaesthesiology (U.S.), Department of Nephrology (M.E.), and Department of Emergency Medicine (M.J.H.), Karolinska University Hospital, Stockholm, Sweden; Swedish Renal Registry (M.E.), Jönköping, Sweden; and Department of Molecular Medicine and Surgery (U.S.), CLINTEC (M.E.), and Department of Internal Medicine (L.R., M.J.H.), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Sartipy
authors.affiliation: From the Department of Anaesthesiology, Surgical Services, and Intensive Care Medicine (L.R.), Department of Cardiothoracic Surgery and Anaesthesiology (U.S.), Department of Nephrology (M.E.), and Department of Emergency Medicine (M.J.H.), Karolinska University Hospital, Stockholm, Sweden; Swedish Renal Registry (M.E.), Jönköping, Sweden; and Department of Molecular Medicine and Surgery (U.S.), CLINTEC (M.E.), and Department of Internal Medicine (L.R., M.J.H.), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Evans
authors.affiliation: From the Department of Anaesthesiology, Surgical Services, and Intensive Care Medicine (L.R.), Department of Cardiothoracic Surgery and Anaesthesiology (U.S.), Department of Nephrology (M.E.), and Department of Emergency Medicine (M.J.H.), Karolinska University Hospital, Stockholm, Sweden; Swedish Renal Registry (M.E.), Jönköping, Sweden; and Department of Molecular Medicine and Surgery (U.S.), CLINTEC (M.E.), and Department of Internal Medicine (L.R., M.J.H.), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Holzmann
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology*; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: acute kidney injury; coronary artery bypass; epidemiology; kidney failure, chronic; prognosis