Clinical Nephrology – Epidemiology – Clinical Trials
Kidney International (2005) 67, 1112–1119; doi:10.1111/j.1523-1755.2005.00177.x
Influence of renal dysfunction on mortality after cardiac surgery: Modifying effect of preoperative renal function
CHARUHASV THAKAR, SARAH WORLEY, SUSANA ARRIGAIN, JEAN-PIERRE YARED and EMIL P PAGANINI
Departments of Nephrology and Hypertension, Biostatistics and Epidemiology, and Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio; and Division of Nephrology and Hypertension, University of Cincinnati Medical Center, Cincinnati, Ohio
Correspondence: Charuhas V. Thakar, M.D., Assistant Professor of Medicine, Division of Nephrology and Hypertension, University of Cincinnati Medical Center, 231 Albert B. Sabin Way, MSB G-259, Cincinnati, OH 45267. E-mail:thakarcv@ucmail.uc.edu
Received 6 August 2004; Revised 22 September 2004; Accepted 11 October 2004.
Abstract
Influence of renal dysfunction on mortality after cardiac surgery: Modifying effect of preoperative renal function.
Background
Acute renal failure (ARF) requiring dialysis is an independent risk factor of mortality after cardiac surgery; the level of preoperative renal function influences the risk of both postoperative ARF and mortality. The relationship between mild renal dysfunction and mortality, and the modifying effect of baseline renal function on this association, is less clear.
Methods
We studied 31,677 patients undergoing cardiac surgery between 1993 and 2002. We used a logistic regression model to assess the relationship between postoperative renal dysfunction and mortality, while adjusting for preoperative renal function, postoperative ARF requiring dialysis, and other risk factors.
Results
The overall postoperative mortality rate was 2.2% (698/31,677). For the entire cohort, a clinically relevant increase in the adjusted risk of mortality occurred beyond 30% decline in postoperative GFR. The mortality rate was 5.9% (N, 292/4986) among patients who developed 30% or greater decline in postoperative GFR not requiring dialysis versus 0.4% (N, 106/26,136) among those with <30% decline (P < 0.001). A significant interaction between preoperative GFR and percent change in postoperative GFR (P < 0.001) indicated that at equivalent degrees of renal dysfunction, the mortality risk was greater at a lower preoperative GFR. ARF requiring dialysis was strongly associated with mortality in the model (odds ratio 4.2; 95% CI 3.1–5.7).
Conclusion
Renal dysfunction not requiring dialysis is an independent risk factor of mortality after cardiac surgery. A better preoperative GFR attenuates the effect of postoperative renal dysfunction on mortality; this interaction needs to be considered while defining a clinically relevant threshold of ARF.
Keywords:
renal dysfunction, mortality, cardiac surgery
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