Impact of renal function impairment assessed by CKDEPI estimated glomerular filtration rate on early and late outcomes after coronary artery bypass grafting. (15th January 2017)

• Record Type: Journal Article
• Authors: Gelsomino, Sandro; Del Pace, Stefano; Parise, Orlando; Caciolli, Sabina; Matteucci, Francesco; Fradella, Giuseppe; Bonacchi, Massimo; Fusco, Simona; Lucà, Fabiana; Marchionni, Niccoló
• Is Part Of: International journal of cardiology. Volume 227(2017)
• Page Start: 778
• Page End: 787
• Publication Date: 2017-01-15
• Subjects: Renal function -- Chronic kidney disease -- Coronary artery bypass -- Glomerular filtration; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.10.059
• Languages: English
• ISSNs: 0167-5273

Abstract

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-EPI able 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 (≥ 60 ml/min/1.73 m 2 ; n = 1199), Group 2 (45–59 ml/min/1.73 m 2 ; n = 358), Group 3 (30–44 ml/min/1.73 m 2 ; n = 171) and Group 4 (≤ 29 ml/min/1.73 m 2 ; n = 126). Median follow-up was 66 months [IQR 46–84]. Results: eGFRCKD-EPI ≤ 30 ml/min/1.73 m 2, ≤ 41 ml/min/1.73 m 2, ≤ 27 ml/min/1.73 m 2 and ≤ 29 ml/min/1.73 m 2 were 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 ≤ 26 ml/min/1.73 m 2, ≤ 25 ml/min/1.73 m 2, ≤ 35 ml/min/1.73 m 2 and ≤ 29 ml/min/1.73 m 2 predicted 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-EPI equation 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.