Is Diabetic Nephropathy a Predicted Risk Factor?  Kaplan-Meier and Multivariate Analysis of Confounding Risk Factors in Off-Pump Coronary Artery Bypass Grafting for Chronic Dialysis Patients

Accelerated atherosclerosis in prolonged maintenance hemodialysis (HD) has been recognized; however, whether HD duration is associated with poor clinical outcome in HD patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation is unknown. We evaluated the impact of HD duration on clinical outcomes in HD patients with CAD after DES implantation. Between April 2007 and December 2012, 168 angina pectoris patients (320 de novo lesions) on HD were treated with DES. Major adverse cardiovascular events (MACE) and target lesion revascularization (TLR) were investigated at 3 years according to the HD duration (≤ 3 years, 83 patients; >3 years, 85 patients). The incidence of MACE was significantly higher in the long HD duration group (25.3 vs. 50.6 %; P = 0.001). Especially, sudden cardiac death (SCD) was significantly higher in the long HD duration group (3.6 vs. 16.5 %; P = 0.006). On the other hand, the rates of TLR were similar between the two groups (12.0 vs. 14.1 %; P = 0.69). Cox's proportional hazard analysis revealed that HD duration (HR 1.08 per year, 95 % CI 1.03-1.13, P = 0.002), β-blocker use (0.28, 0.17-0.46, P < 0.001), and diabetes mellitus (2.10, 1.23-3.56, P = 0.007) were independent predictors of MACE. Longer HD duration did not affect TLR; however, SCD was significantly higher in the long HD duration group.

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Effects of Renin-Angiotensin System Inhibitors on the Occurrence of Acute Kidney Injury Following Off-Pump Coronary Artery Bypass Grafting

Yoo

Youn

Shim

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp s the indications for renin-angiotensin system (RAS) inhibitors expand for secondary prevention in patients with coronary artery disease, 1 an increasing number of patients presenting for coronary artery bypass graft surgery (CABG) have had chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker administration. Although continued RAS inhibitor therapy is associated with improved survival and retarded progression of renal disease, 2-4 concerns about the development acute kidney injury (AKI) in situations associated with decreased glomerular filtration pressure have been raised. 2,5,6 Editorial p 1800Indeed, cardiac surgery under cardiopulmonary bypass (CPB) is significantly associated with changes in the glomerular filtration rate and volume shift. Chronic preoperative RAS inhibitor therapy reportedly resulted in 28% increased risk of AKI following cardiac surgery, suggesting withholding of these medications prior to surgery. 2 However, from the currently available evidence no definite conclusion can be drawn on withdrawing RAS inhibitors prior to CABG at the expense of losing their anti-ischemic benefits. 2,7Use of the off-pump CABG (OPCAB) technique in patients presenting with high surgical risk has increased, with preferable results. 8-10 CPB itself is considered one of the main etiologic factors in the development of AKI. 11-14 In addition, because RAS inhibitor-associated AKI is more likely to develop under certain conditions, such as hypovolemia and renal hypoperfusion, 15,16 we hypothesized that preload augmentation before distal anastomosis and maintenance of pulsatile blood flow and pressure during surgery would mitigate the effect of RAS inhibitors on renal function after OPCAB. However, comprehensive data to support Background: Despite several studies that evaluated the effects of renin-angiotensin system (RAS) inhibitors on postoperative renal function in cardiac surgery patients, no final conclusions are available. The aim of the present study was to determine the effect of RAS inhibitors on renal function following off-pump coronary artery bypass grafting (OPCAB).

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Is Diabetic Nephropathy a Predicted Risk Factor? Kaplan-Meier and Multivariate Analysis of Confounding Risk Factors in Off-Pump Coronary Artery Bypass Grafting for Chronic Dialysis Patients

Cited by 6 publications

References 29 publications

OPCAB Made in Japan: Evidence on Off-Pump Coronary Artery Bypass Grafting from Japan

OPCAB Made in Japan: Evidence on Off-Pump Coronary Artery Bypass Grafting from Japan

Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation

Effects of Renin-Angiotensin System Inhibitors on the Occurrence of Acute Kidney Injury Following Off-Pump Coronary Artery Bypass Grafting

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