title: Does the Stage of Chronic Kidney Failure Influence the Outcome in Cardiac Surgery?
abstract: BACKGROUND
  The number of patients with chronic kidney failure requiring cardiac surgery is continuously increasing. Additionally, significant worsening in the overall risk profile of this group of patients is noted.
  
  
  OBJECTIVE
  To investigate the effect of chronic renal dysfunction both in non-dialysis-dependent renal failure and end-stage renal failure patients, on early mortality--morbidity and late survival in a series of cardiac surgery patients at our institution.
  
  
  METHODS
  1344 patients who had open heart surgery at our university hospital between 2010 and 2013 were retrospectively reviewed. Chronic renal dysfunction was defined according to preoperative glomerular filtration rate. Patients selection (n=80). Group 1 mild--(GRF 59-30 mL/min), Group 2 moderate--(GFR 29-15 mL/min), Group 3 end stage--(GFR<15 mL/min) renal failure.
  
  
  RESULTS
  Chronic renal dysfunction was present in 5.95% of all patients studied. Group 1--55 (68.75%), Group 2--16 (20%), Group 3--9 (11.25%). No difference between the groups in the need for heart inotropic support was noted; however the use of these medications was necessary in 60.6% of all studied patients. Forty nine percent in Group 1, 87.5% in Group 2 and 77% in Group 3, respectively. Renal replacement therapy in the early postoperative period was needed in 12 patients, with significance between the groups (p = 0.001). The overall hospital mortality was 2.5%. Follow-up was completed with a mean of 1.4 years (range 2 months to 4 years). There were 6 (7.5%) late deaths.
  
  
  CONCLUSIONS
  Our observations do not exhibit large variations in postoperative complications and deaths in patients with chronic renal failure, depending on the degree of preoperative renal function impairment. It seems that renal failure regardless of the degree of impairment is a factor aggravating the intra and post-operative course in cardiac surgery patients.
authors.affiliation: Department of Cardiac Surgery, Wroclaw Medical University, Poland.
authors.forename: Anna T
authors.initials: AT
authors.lastname: Goździk
authors.affiliation: Department of Cardiac Surgery, Wroclaw Medical University, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Jakubaszko
authors.affiliation: Department of Cardiology, Wroclaw Medical University, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Grzebieniak
authors.affiliation: Cardiac Surgery Clinic, Wroclaw Medical University, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kustrzycki
authors.affiliation: Department of Anesthesiology and Intensive Care, Wroclaw Medical University, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Goździk
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome