title: Impact of renal function impairment assessed by CKDEPIestimated glomerular filtration rate on early and late outcomes after coronary artery bypass grafting.
abstract: BACKGROUND
  We explore the association between short- and long- term adverse outcomes following coronary artery bypass grafting (CABG) and the degree of preoperative renal dysfunction classified on glomerular fraction estimated with Chronic Kidney Disease-Epidemiology Collaboration equation (eGFRCKD-EPI). We also try to identify cut-off values of eGFRCKD-EPIable to predict post-CABG unfavorable events and assess whether a reclassification with new thresholds is necessary.
  
  
  METHODS
  One-thousand-one-hundred-eighty-six consecutive patients undergoing CABG between 2005 and 2014 were categorized in 4 groups according to the eGFRCKD-EPI: Group 1 (≥60ml/min/1.73m2; n=1199), Group 2 (45-59ml/min/1.73m2; n=358), Group 3 (30-44ml/min/1.73m2; n=171) and Group 4 (≤29ml/min/1.73m2; n=126). Median follow-up was 66months [IQR 46-84].
  
  
  RESULTS
  eGFRCKD-EPI≤30ml/min/1.73m2, ≤41ml/min/1.73m2, ≤27ml/min/1.73m2and ≤29ml/min/1.73m2were strong predictors of early mortality (OR 5.88 [95% CI 2.59-11.25]), stroke (2.59 [1.43-3.71]), prolonged length of stay (3.49 [1.24-5.92]) and postoperative dialysis (3.68 [1.34-4.91]), respectively. In addition, eGFRCKD-EPI≤26ml/min/1.73m2, ≤25ml/min/1.73m2, ≤35ml/min/1.73m2and ≤29ml/min/1.73m2predicted all-cause death (hazard ratio 2.74 [95% CI 2.10-3.92] cardiovascular death (sub-hazard ratio 2.11 [95% CI 1.42-3.90]), myocardial infarction (2.01 [1.32-3.70]) and heart failure (2.24 [1.41-3.93]), respectively. Analyses corrected by age and left ventricular ejection fraction confirmed these findings.
  
  
  CONCLUSIONS
  In our experience, the use of the eGFRCKD-EPIequation led to categorization with a significantly lower number of patients at risk for post-CABG complications. This might have important clinical repercussions on allocation of healthcare resources and more targeted prevention and management of CABG complications.
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy. Electronic address: sandro.gelsomino@libero.it.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Pace
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Orlando
authors.initials: O
authors.lastname: Parise
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Caciolli
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Matteucci
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fradella
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bonacchi
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Fusco
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lucà
authors.affiliation: Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
authors.forename: Niccoló
authors.initials: N
authors.lastname: Marchionni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000639:trends*; D016021:Epidemiologic Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Chronic kidney disease; Coronary artery bypass; Glomerular filtration; Renal function