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(Circulation. 2005;112:I-270 – I-275.)
© 2005 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Relation Between Mild Renal Dysfunction and Outcomes After Coronary Artery Bypass Grafting

Rosita Zakeri, MB, ChB; Nick Freemantle, MA, PhD; Vivian Barnett; Graham W. Lipkin, MD, FRCP; Robert S. Bonser, FRCS, FRCP; Timothy R. Graham, FRCS; Stephen J. Rooney, FRCS; Ian C. Wilson, MD, FRCS; Robert Cramb, FRCPath; Bruce E. Keogh, MD, FRCS; Domenico Pagano, MD, FRCS

From the Cardiothoracic Surgical Unit (R.Z., V.B., R.S.B., T.R.G., S.J.R., I.C.W., B.E.K., D.P.), the Department of Primary Care and General Practice (N.F.), the Department of Nephrology (G.W.L.), and Clinical Chemistry (R.C.), University Hospital Birmingham, Edgbaston, United Kingdom.

Correspondence to Dr D. Pagano, University Hospital Birmingham, Edgbaston B15 2 TH, United Kingdom. E-mail domenico.pagano{at}uhb.nhs.uk

Background— Risk stratification algorithms for coronary artery bypass grafting (CABG) do not include a weighting for preoperative mild renal impairment defined as a serum creatinine 130 to 199 µmol/L (1.47 to 2.25 mg/dL), which may impact mortality and morbidity after CABG.

Methods and Results— We reviewed prospectively collected data between 1997 and 2004 on 4403 consecutive patients undergoing first-time isolated CABG with a preoperative serum creatinine <200 µmol/L (2.26 mg/dL)] in a single institution. The in-hospital mortality was 2.5% (112 of 4403), the need for new dialysis/hemofiltration was 1.3% (57 of 4403), and the stroke rate was 2.5% (108 of 4403). There were 458 patients with a serum creatinine 130 to 199 µmol/L or 1.47 to 2.25 mg/dL (mild renal dysfunction group) and 3945 patients with a serum creatinine <130 µmol/L (<1.47 mg/dL). Operative mortality was higher in the mild renal dysfunction group (2.1% versus 6.1%; P<0.001) and increased with increasing preoperative serum creatinine level. New dialysis/hemofiltration (0.8%versus 5.2%; P<0.001) and postoperative stroke (2.2% versus 5.0%; P<0.01) were also more common in the patients with mild renal impairment. Multivariate analysis adjusting for known risk factors confirmed preoperative mild renal impairment (creatinine 130 to 199 µmol/L or 1.47 to 2.25 mg/dL; odd ratio, 1.91; 95% CI, 1.18 to 3.03; P=0.007) or glomerular filtration rate estimates <60 mL/min per 1.73 m², derived using the Cockroft-Gault formula, (odds ratio, 1.98; 95% CI, 1.16 to 3.48; P=0.015) as independent predictors of in-hospital mortality. Preoperative mild renal dysfunction adversely affected the 3-year survival probability after CABG (93% versus 81%; P<0.001).

Conclusions— Mild renal dysfunction is an important predictor of outcome in terms of in-hospital mortality, morbidity, and midterm survival in patients undergoing CABG.

Key Words: coronary artery bypass grafting • coronary disease • renal dysfunction