title: Impact of Chronic Kidney Disease on Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus.
abstract: BACKGROUND
  The aim of this study was to compare the short- and long-term outcomes of CABG in diabetes mellitus (DM) patients according to eGFR.
  
  
  RESULTS
  A total of 573 DM patients receiving CABG between 1997 and 2012 were stratified according to preoperative eGFR: normal or mild chronic kidney disease (CKD), eGFR ≥60 ml/min/1.73 m(2); moderate CKD, eGFR 30-60 ml/min/1.73 m(2); severe CKD, eGFR <30 ml/min/1.73 m(2); and severe CKD requiring hemodialysis (HD). Off-pump and bilateral internal thoracic artery (BITA) grafting rates were 83.4 and 62.3%, respectively. Mediastinitis and in-hospital mortality rates were both 1.4%. On logistic regression analysis, preoperative congestive heart failure and CKD severity were independent predictors of postoperative renal failure and major complications. The mean follow-up period was 5.7 years (range, 0-15.5 years). Estimated 5-year survival (92.9±1.6%, 82.8±3.3%, and 47.3±7.0%, respectively, P<0.001) significantly decreased with declining kidney function. On Cox hazard modeling, CKD severity was an independent predictor of major cerebrocardiovascular events (normal/mild: hazard ratio [HR], 1; moderate: HR, 1.35; severe: HR, 1.83; HD: HR, 2.0, P=0.016) and of overall survival (normal/mild: HR, 1; moderate: HR, 1.65; severe: HR, 5.96; HD: HR, 10.93, P<0.001). BITA grafting was a strong protective factor for overall survival (HR, 0.63; P=0.022).
  
  
  CONCLUSIONS
  In DM patients, early- and long-term outcomes after CABG are strongly influenced by CKD progression.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine.
authors.forename: Suguru
authors.initials: S
authors.lastname: Ohira
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Doi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Numata
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Hidetake
authors.initials: H
authors.lastname: Kawajiri
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D051437:Renal Insufficiency / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate