Kidney Function After Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery

Garg, Amit X.; Devereaux, P. J.; Yusuf, Salim; Cuerden, Meaghan; Parikh, Chirag R.; Coca, Steven G.; Walsh, Michael; Novick, Richard J.; Cook, Richard J.; Jain, Anil; Pan, Xiangbin; Noiseux, Nicolas; Vik, Karel; Stolf, Noedir A. G; Ritchie, Andrew J.; Favaloro, Roberto; Parvathaneni, Sirish; Whitlock, Richard; Ou, Yongning; Lawrence, Mitzi; Lamy, André

doi:10.1001/jama.2014.4952

Cited by 181 publications

(159 citation statements)

References 37 publications

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“…34 However, amelioration of acute kidney injury, indicated by a small rise in serum creatinine, has not led to improvements in patient-important outcomes with other interventions in cardiac surgery. 35 Note: CI = confidence interval, RIPC = remote ischemic preconditioning, RR = relative risk. *Excluding patients who underwent preoperative dialysis.…”

Section: Discussionmentioning

confidence: 99%

Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial

Walsh

Whitlock

Garg

et al. 2015

CMAJ

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Section: Discussionmentioning

confidence: 99%

Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial

Walsh

Whitlock

Garg

et al. 2015

CMAJ

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“…[10][11][12][13] In a recently published randomized, controlled trial, the risk of AKI and loss of renal function was investigated after off-pump versus on-pump CABG. 14 The authors found that off-pump surgery reduced the risk of postoperative AKI but not loss of renal function at 1 year after surgery. In summary, studies of various cohorts found an increased risk of ESRD in patients with AKI.…”

Section: Clinical Perspective On P 2011mentioning

confidence: 98%

Acute Kidney Injury After Coronary Artery Bypass Grafting and Long-Term Risk of End-Stage Renal Disease

et al. 2014

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Background-Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) and is associated with adverse outcomes. However, the relationship between AKI after CABG and the long-term risk of endstage renal disease (ESRD) is unknown. Methods and Results-This study included 29 330 patients who underwent primary isolated CABG in Sweden between2000 and 2008. AKI was classified according to the Acute Kidney Injury Network (AKIN) classification: stage 1, >0.3 mg/dL (>26 μmol/L) or 50% to 100% increase; stage 2, 100% to 200% increase; and stage 3, >200% increase from the preoperative to postoperative serum creatinine level. Cox proportional hazards regression analysis was used to calculate hazard ratios with 95% confidence intervals for ESRD in AKIN stage 1 and stage 2 to 3. Postoperative AKI occurred in 13% of patients. During a mean follow-up of 4.3±2.4 years, 123 patients (0.4%) developed ESRD, including 50 (1.6%) in AKIN stage 1, 29 (5.2%) in AKIN stage 2 to 3, and 44 (0.2%) without AKI after CABG. After multivariable adjustment, the hazard ratio for ESRD was 2.92 (95% confidence interval, 1.87-4.55) for AKIN stage 1 and 3.81 (95% confidence interval, 2.14-6.79) for AKIN stage 2 to 3. Conclusions-This nationwide study of patients who underwent CABG found that a small increase in the postoperative serum creatinine level was associated with an almost 3-fold increase in the long-term risk of ESRD after adjustment for a number of confounders, including preoperative renal function. According to Recommended Therapies (SWEDEHEART) registry. 15This registry includes all patients who have undergone coronary angiography, percutaneous coronary intervention, or cardiac surgery in Sweden since 1992, with complete coverage of the whole country. Agreement between information in the registry and the medical records was reported to be between 93% and 97%. 15 The present study included all patients who underwent CABG in Sweden between 2000 and 2008. The exclusion criteria are shown in Figure 1. Patients were excluded if they had undergone prior cardiac surgery, had undergone vascular or valvular surgery concurrently with CABG, had missing preoperative or postoperative s-Cr levels, had undergone surgery within 24 hours of the decision to operate, had a preoperative estimated glomerular filtration rate (eGFR) of <15 mL·min, or were dialysis dependent before surgery. Diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and hyperlipidemia were recorded if patients were receiving ongoing pharmacological treatment for these conditions.Patients were usually reviewed by a cardiologist a few weeks after surgery and then followed up by their family doctor.The study complied with the guidelines of the Declaration of Helsinki and was approved by the regional ethics review board in Stockholm. The postoperative s-Cr level recorded in the SWEDEHEART registry is the highest level measured during the postoperative hospital stay. In a subgroup of 483 patients who underwent CABG at 1 center (Karolinsk...

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“…The existence of CKD as well as chronic hypertension may affect the ideal mean arterial pressure, because renal injury seems to be accompanied by a loss of autoregulation (125,126). Some data suggest that off-pump coronary artery bypass (OPCAB) surgery reduces the incidence of perioperative AKI (127-131); however, this finding is not universal (131,132). Furthermore, the reduction in AKI may not necessarily affect long-term kidney outcomes (125).…”

Section: Cardiopulmonary Bypassmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

261

198

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Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

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Kidney Function After Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery

Abstract: clinicaltrials.gov Identifier: NCT00463294.

Cited by 181 publications

References 37 publications

Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial

Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial

Acute Kidney Injury After Coronary Artery Bypass Grafting and Long-Term Risk of End-Stage Renal Disease

AKI Associated with Cardiac Surgery

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