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VOLUME 12 , ISSUE 4 ( December, 2008 ) > List of Articles

ORIGINAL ARTICLE

Impact of preoperative mild renal dysfunction on short term outcome in isolated coronary artery bypass (CABG) patients

M. N. Ramakrishna, Ratan Gupta, V. Deviprasad Hegde, G. N. Kumarswamy, Narayana Swamy Moola, K. P. Suresh

Keywords : CABG-coronary arteries bypass graft, CPB-cardiopulmonary bypass, GFR-glomerular filtration rate, Mild renal dysfunction

Citation Information : Ramakrishna MN, Gupta R, Hegde VD, Kumarswamy GN, Moola NS, Suresh KP. Impact of preoperative mild renal dysfunction on short term outcome in isolated coronary artery bypass (CABG) patients. Indian J Crit Care Med 2008; 12 (4):158-162.

DOI: 10.4103/0972-5229.45075

License: CC BY-ND 3.0

Published Online: 01-12-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and Aim: It is well known that dialysis dependent renal failure increases the likelihood of poor outcome following cardiac surgery. But the results of CABG in patients with mild renal dysfunction are not clearly established. The aim of the study is to analyze the risk of preoperative mild renal dysfunction on outcome after isolated coronary surgery. Materials and Methods: We reviewed prospectively collected data between June 2006-Nov 2006 in 488 patients who underwent isolated CABG. We separated the data into two groups. Control group having normal renal function and study group having mild renal dysfunction (serum creatinine 1.4 mg-2.2 mg%). Among 488 patients, 412 patients were in control group and 76 patients were in the study group. Results: Analysis of data showed significant postoperative complications in the mild renal dysfunction group, like increased operative mortality (7.5% vs 1.6%), increased requirement of postoperative renal replacement therapy (10% vs 1.2%), increased incidence of new onset atrial fibrillation (20% vs 4.2%) and prolonged duration of ICU stay. Multivariate analysis adjusting for known risk factors confirmed preoperative mild renal dysfunction (S.creat.1.4-2.2 mg/dl) is an independent risk factor for postoperative morbidity and mortality. (Adj. OR: 4.47; 95% CI: 1.41-14.16; P=0.010). Conclusion: Mild renal dysfunction is an important independent predictor of outcome in terms of in-hospital mortality and morbidity in patients undergoing CABG.


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  1. Long-term survival of dialysis patients after coronary bypass grafting. Ann Thorac Surg 2002;74:458-62.
  2. European system for cardiac operation risk evaluation. (EuroSCORE). Eur J Cardiothorac Surg 1999;16:9-13.
  3. A method of uniform stratification of risk for evaluating the results of surgery in acquired heart disease. Circulation 1989;78:I3-12.
  4. Overview: Increased cardivasular in patients with minor renal dysfunction: An emerging issue with for reaching consequences. J Am Soc Nephrol 2004;15:513-6.
  5. Prognostic factors in treated hypertension. J Hypertens Suppl 1985;3:S497-500.
  6. Renal function: The Cinderella of cardiovascular risk profile. J Am Coll Cardiol 2001;38:1782-7.
  7. Minor renal dysfunction: An emerging independent cardiovascular risk factor. Heart 2003;89:963-4.
  8. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: The HOPE randomized trial. Ann Intern Med 2001;134:629-36.
  9. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-34.
  10. Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery: VA Cooperative Study #5. Kidney Int 1999;55:1057-62.
  11. Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine > or =2.0 mg/dl). Eur J Cardiothorac Surg 2001;20:565-72.
  12. Renal afferent denervation prevents hypertension in rats with chronic renal failure. Hypertension 1995;25:878-82.
  13. Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 1992;327:1912-8.
  14. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 1974;290:697-701.
  15. Novel mechanism for endothelial dysfunction: Dysregulation of dimethylarginine dimethylaminohydrolase. Circulation 1999;99:3092-5.
  16. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation 2005;112:I270-5.
  17. Coronary artery bypass grafting in non-dialysis-depedent mild-to-moderate renal dysfunction. J Thorac Cardiovasc Surg 2001;121:1083-9.
  18. Mild and moderate renal dysfunction: impact on short term outcome. Eur J Cardiothorac Surg 2007;32:286-90.
  19. Youhana. Long and short-term outcomes in patients requiring continuous renal replacement therapy post cardiopulmonary bypass. Eur J Cardiothorac Surg 2005;27:906-9.
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