The relationship of preoperative estimated glomerular filtration rate and outcomes after cardiovascular surgery in patients with normal serum creatinine: a retrospective cohort study

Abstract

Background Although serum creatinine concentration has been traditionally used as an index of renal function in clinical practice, it is considered relatively inaccurate, especially in patients with mild renal dysfunction. This study investigated the usefulness of preoperative estimated glomerular filtration rate (eGFR) in predicting complications after cardiovascular surgery in patients with normal serum creatinine concentrations. Methods This study included 2208 adults undergoing elective cardiovascular surgery. Preoperative eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration equations. The relationships between preoperative eGFR and 90 day postoperative composite major complications were analyzed, including 90 day all-cause mortality, major adverse cardiac and cerebrovascular events, severe acute kidney injury, respiratory and gastrointestinal complications, wound infection, sepsis, and multi-organ failure. Results Of the 2208 included patients, 185 (8.4%) had preoperative eGFR < 60 mL/min/1.73 m 2 and 328 (14.9%) experienced postoperative major complications. Multivariable logistic regression analyses showed that preoperatively decreased eGFR was independently associated with an increased risk of composite 90 day major postoperative complications (adjusted odds ratio: 1.232; 95% confidence interval [CI]: 1.148–1.322; P < 0.001). eGFR was a better discriminator of composite 90 day major postoperative complications than serum creatinine, with estimated c-statistics of 0.724 (95% CI: 0.694–0.754) for eGFR and 0.712 (95% CI: 0.680–0.744) for serum creatinine ( P = 0.008). Conclusions Decreased eGFR was significantly associated with an increased risk of major complications after cardiovascular surgery in patients with preoperatively normal serum creatinine concentrations. Electronic supplementary material The online version of this article (10.1186/s12871-019-0763-1) contains supplementary material, which is available to authorized users.

Perioperative Management and Outcomes of Hip Fracture Patients with Advanced Chronic Kidney Disease

“…Similar to previous studies, 19 - 21 our findings suggest an inverse relationship between eGFR and postoperative mortality in patients with eGFR ≤ 12 on admission. A systematic review and meta-analysis on cardiac and vascular surgeries demonstrated an elevated relative risk of mortality of 2.85 and 3.75 in patients with eGFR of < 30 mL/min/1.73 m 2 and < 15 mL/min/1.73 m 2 respectively compared to normal eGFR of > 90 mL/min/1.73 m 2 .…”

Frequency and factors affecting the development of acute kidney injury following open heart surgery

“…We found no significant differences in terms of preoperative ACEinh usage. Potentially nephrotoxic drugs (such as NSAII, aminoglycosides, radiocontrast agents, ACEinh, Angiotensin receptor blockers) are recommended to be discontinued in patients scheduled for cardiac surgery, if possible [14]. A retrospective study indicated that prophylactic use of statins in the preoperative period would have a prophylactic effect on the prevention of postoperative AKI.…”

“…The mortality rate can reach up to 60%. In retrospective studies, a 30% decrease in GFR increased mortality by 4-6% in patients after cardiac surgery [11][12][13][14]. In a prospective cohort study of 43,642 patients after CABG and valvular surgery, the 30-day mortality was 64 % in patients needing hemodialysis after surgery, and 4% in patients without renal injury [15].…”

“…Common intraoperative risk factors for AKI after cardiac surgery include surgery type (valvular, valvular and coronary, emergent or redo surgery), cardiopulmonary bypass time greater than 100-120 minutes, presence of hemodilution, hemolysis and embolism [11]. Jang et al [14] reported that surgery type was not a risk factor for AKI after cardiac surgery. In this retrospective study, 30.6% CABG, 40% isolated valvular surgery and 4.8% both surgeries were performed.…”

Muscle-related parameters-based machine learning model for predicting postinduction hypotension in patients undergoing colorectal tumor resection surgery

“…Previous studies have shown that PIH is caused by multiple factors; however, the exact pathophysiological mechanisms are not fully understood. PIH is induced by multiple factors, such as the patient’s physical condition and anesthesia management ( 4 ).…”