Chronic kidney disease as major determinant of the renal risk related to on-pump cardiac surgery: a single-center cohort study

Hougardy, Jean-Michel; Revercez, Perrine; Pourcelet, Aline; Oumeiri, Bachar Ghassan El; Racapé, Judith; Moine, Alaín Le; Eynden, Frédéric Vanden; Backer, Daniel De

doi:10.1080/00015458.2016.1156929

Cited by 4 publications

(6 citation statements)

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“…As previously described, patients with preoperative renal dysfunction are at an increased risk of developing postoperative AKI 19, 27 , even those patients who exhibit proteinuria without an observed decrease in eGFR 28, 29 . Given the increased mortality and morbidity associated with CKD and AKI independently, these effects of these complications are worse when they occur together 6, 7, 14 .…”

Section: Outcomes - Mortalitymentioning

confidence: 77%

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Lysak

Bïhorac

Hobson

2017

Current Opinion in Anaesthesiology

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Purpose Acute and chronic kidney diseases (AKI and CKD) have far-reaching implications for surgical patients in regards to postoperative outcomes and hospital cost. We review the recent literature on the effects of AKI and CKD on morbidity, mortality, and resource utilization among cardiac surgery patients. Recent findings Both AKI and CKD increase the risk for short and long-term mortality, morbidity, length of stay, and hospital cost among postoperative patients, with increasing disease stage correlating with worse outcomes. Even the mildest forms of AKI (RIFLE-R) and CKD (proteinuria without an observed reduction in eGFR) demonstrate worse clinical outcomes compared to patients with no AKI or CKD. Outcomes are worse even in patients who achieve full renal recovery before hospital discharge. These complications dramatically increase ICU length of stay, hospital length of stay, resource utilization, and both in-hospital and post-discharge costs, as evidenced by lower rates of discharges to home. Summary Acute and chronic kidney diseases remain prevalent, morbid, and costly conditions for cardiac surgery patients. Better risk stratification, early diagnosis, and earlier interventions are needed to prevent the consequences of these diseases.

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Section: Outcomes - Mortalitymentioning

confidence: 77%

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Lysak

Bïhorac

Hobson

2017

Current Opinion in Anaesthesiology

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“…Upon reviewing previous studies, we found that 5 papers had the same study outcome as ours. By studying 252 patients undergoing cardiac surgery under cardiopulmonary bypass, Jean-Michel Hougardy et al found that baseline renal function can predict postoperative acute kidney injury and poor prognosis (15). Pablo Jorge Monjas and others found that renal function can be used as an important predictor of postoperative acute kidney injury.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Creatinine Clearance and Mortality of Elective Cardiac Surgery in Hospitalization: A Secondary Analysis

Chen

Song

Qian

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveIt has been reported that poor renal function before surgery is related to poor prognosis. However, there is no specific discussion on the ideal value of preoperative creatinine clearance. Consequently, our primary goal is to explore the correlation between baseline creatinine clearance and short-term mortality after cardiac surgery.MethodsWe conducted a secondary data analysis based on a French cardiac surgery cohort. The cohort included 6,889 participants in a Paris university hospital from December 2005 to December 2012. The exposure variable and outcome variable used in this secondary analysis were the preoperative creatinine clearance rate and postoperative hospital mortality. Multivariate logistic regression and generalized additive models were employed.ResultsThe nonlinear relationship between the preoperative creatinine clearance rate and postoperative death was observed in this study. The preoperative creatinine clearance rate was negatively correlated with postoperative mortality in the range of 8.9–78.5 in patients younger than 80 years old (odds ratio = 0.98, 95% confidence interval 0.97–0.98, in Cockcroft Gault formulae). However, this effect characteristics reaches saturation after the preoperative creatinine clearance rate exceeds 78.5 (odds ratio = 0.99, 95% confidence interval 0.98–1.00, CG). In patients with history of thromboembolic event and coronary artery disease, the saturation effect were 30.8 mL.min−1 (CG) and 56.6 mL.min−1(CG).ConclusionIn the range of 8.9–78.5 (Cockcroft), an increase in preoperative creatinine clearance is associated with a decrease in postoperative mortality with patients younger than 80 years old. In patients with a history of embolism and coronary artery disease, the cut-off points of the reduction in preoperative creatinine clearance associated with a increase in postoperative mortality are 30.8 mL.min−1 and 56.6 mL.min−1.

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“…We have [13] patients in the pump group [43%] Vs. [3] patients in the off-pump group [10%] who had impaired postoperative kidney functions. In the on-pump group, there were [9] patients who required dialysis [30%], and they were among the group of [13] patients who were diagnosed as postoperative renal dysfunction, while in the offpump group [2] patients required dialysis [6.76%] and they were among the [3] patients who had postoperative renal dysfunction. Comparing that to other studies as following Mahmoud et al [8] that shows [27%] of patients in pump group who had impaired postoperative renal dysfunction and [7%] of those had needed renal dialysis while in the offpump group [6%] of patients had impaired postoperative renal functions and [2.3%] of those needed hemodialysis and also Arslan et al [20] that shows [18.75 %] of patients in the pump group who needed renal dialysis while in the off-pump group [2.77%] only needed renal dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary artery bypass grafting [CABG] performed using cardiopulmonary bypass [CPB] has been the ideal treatment for patients with ischemic heart disease. However, there has been increasing evidence that CPB may be responsible for part of the morbidity associated with CABG surgery [2] .…”

Section: Introductionmentioning

confidence: 99%

“…Patients with low EF and impaired renal functions preoperatively have significant intraoperative and postoperative complications and mortality and require an efficient preoperative assessment to verify surgical indication and optimum intervention modalities to decrease these consequences [2] . Perioperative renal impairment is the main determinant of operative and long-term mortality following surgery.…”

Section: Introductionmentioning

confidence: 99%

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OFF PUMP VERSUS ON PUMP CORONARY ARTERY BYPASS SURGERY in ISCHEMIC HEART DISEASE PATIENTS with IMPAIRED CONTRACTILITY and RENAL DYSFUNCTION ;ACOPARATIVE STUDY.

Abdelsamad¹,

Hassan

Sharaa

et al. 2020

International Journal of Medical Arts

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Background: Coronary artery bypass surgery using cardiopulmonary bypass [CPB] carries the risk of renal impairment, which cannot be attributed to a single factor. This study compared the off-pump technique with the on-pump technique on kidney function in ischemic heart disease patients. Aim of the work:The study aimed to compare off-pump with on-pump technique on kidney and heart functions in patients with renal impairment with no need for dialysis but with impaired Ejection fraction [EF]. Patients and methods:This prospective non-randomized study included 60 patients who presented with symptoms of ischemic heart disease and subsequently underwent myocardial revascularization with preoperative serum creatinine levels between 1.6 to 2.5 mg/dl and EF below 45%. Patients were as following: Group A patients [on-pump]: included those who underwent surgery on cardiopulmonary bypass. Group B patients [off-pump]: included those who underwent off-pump surgery. Both groups were compared in terms of renal impairment markers and needed for dialysis and early postoperative outcome.Results: Renal impairment needs management by dialysis was developed in nine patients [30%] in the pump group [group I] and two patients [7.67%] in the off-pump group, with a significant difference. Group [I] showed a significant increase of transfused blood, blood urea nitrogen, serum creatinine, acute kidney injury [13 patients], reopening for bleeding, postoperative renal impairment, need for renal dialysis, total intensive care unit stay, and the total duration of hospital admission. However, it had a significant reduction in hemoglobin and creatinine clearance. Conclusion:Off-pump coronary revascularization offers a better kidney function preservation and has a decreased risk for kidney dysfunction in patients with renal impairment without dialysis compared with coronary revascularization with cardiopulmonary bypass.

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Chronic kidney disease as major determinant of the renal risk related to on-pump cardiac surgery: a single-center cohort study

Abstract: On-pump CSA-AKI was observed in nearly 15% of cases and was associated with poorer outcomes. Interestingly, the risk of CSA-AKI could be estimated preoperatively, thanks to the basal renal function, which exhibited an equal performance to the STS score.

Cited by 4 publications

References 28 publications

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Mortality and cost of acute and chronic kidney disease after cardiac surgery

Preoperative Creatinine Clearance and Mortality of Elective Cardiac Surgery in Hospitalization: A Secondary Analysis

OFF PUMP VERSUS ON PUMP CORONARY ARTERY BYPASS SURGERY in ISCHEMIC HEART DISEASE PATIENTS with IMPAIRED CONTRACTILITY and RENAL DYSFUNCTION ;ACOPARATIVE STUDY.

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