Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery.
OBJECTIVE
Chronic kidney disease (CKD) and anemia are independent preoperative risk factors for coronary artery bypass graft (CABG) surgery. We evaluated the implications of the coexistence of these two factors and their associated prognosis for CABG surgery.


METHODS
We analyzed, retrospectively, consecutive patients who underwent elective CABG surgery between 2004 and 2014. The patients were classified into four groups depending on the presence or absence of preoperative CKD and anemia. We assessed the major adverse cardiac and cerebrovascular event (MACCE), defined as composite outcomes of cardio- and cerebrovascular death, revascularization through surgery or percutaneous intervention, hospitalization for congestive heart failure, and cerebral infarction.


RESULTS
The study population consisted of 510 patients (73 % male; median age 71 years old), followed up for a median period of 2.8 years. Multivariate analysis indicated that neither the CKD/no-anemia group [hazard ratio (HR) 0.98, 95 % confidence interval (CI) 0.39-2.51, P = 0.973] nor the no-CKD/anemia group (HR 1.20, 95 % CI 0.69-2.09, P = 0.512) had significantly poorer prognoses than the no-CKD/no-anemia group. However, the CKD/anemia group had a significantly higher risk of a MACCE (HR 2.01, 95 % CI 1.01-3.98, P = 0.046).


CONCLUSIONS
The presence of both CKD and anemia in patients undergoing CABG for coronary artery disease is synergistically associated with a worse outcome.
Department of Cardiovascular Surgery, Kameda Medical Center, Chiba, Japan.
Takuya
T
Ogami
Department of Cardiology, Kameda Medical Center, 929, Higashi-Cho, Kamogawa, Chiba, Japan. yuya8950@gmail.com.
Yuya
Y
Matsue
Department of Cardiovascular Surgery, Kameda Medical Center, Chiba, Japan.
Ryo
R
Kawasumi
Department of Cardiovascular Surgery, Kameda Medical Center, Chiba, Japan.
Hiroaki
H
Tanabe
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000209:etiology; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors
Coronary artery disease; Hemoglobin; Prognosis; Renal function