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(Circulation. 2006;113:1063-1070.)
© 2006 American Heart Association, Inc.

Cardiovascular Surgery

Impact of Renal Dysfunction on Outcomes of Coronary Artery Bypass Surgery

Results From the Society of Thoracic Surgeons National Adult Cardiac Database

William A. Cooper, MD; Sean M. O’Brien, PhD; Vinod H. Thourani, MD; Robert A. Guyton, MD; Charles R. Bridges, MD, ScD; Lynda A. Szczech, MD, MSCE; Rebecca Petersen, RN; Eric D. Peterson, MD, MPH

From the Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, Atlanta, Ga (W.A.C., V.H.T., R.A.G., R.P.); University of Pennsylvania Medical Center, Philadelphia (C.R.B.); and Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University, Durham, NC (S.M.O., L.A.S., E.D.P.).

Correspondence to Eric D. Peterson, MD, MPH, Duke Clinical Research Institute, Box 17969, Durham, NC 27715. E-mail peter016{at}mc.duke.edu

Received February 6, 2004; de novo received July 29, 2005; revision received November 28, 2005; accepted December 16, 2005.

Background— Although patients with end-stage renal disease are known to be at high risk for mortality after coronary artery bypass graft (CABG) surgery, the impact of lesser degrees of renal impairment has not been well studied. The purpose of this study was to compare outcomes in patients undergoing CABG with a range from normal renal function to dependence on dialysis.

Methods and Results— We reviewed 483 914 patients receiving isolated CABG from July 2000 to December 2003, using the Society of Thoracic Surgeons National Adult Cardiac Database. Glomerular filtration rate (GFR) was estimated for patients with the use of the Modification of Diet in Renal Disease study formula. Multivariable logistic regression was used to determine the association of GFR with operative mortality and morbidities (stroke, reoperation, deep sternal infection, ventilation >48 hours, postoperative stay >2 weeks) after adjustment for 27 other known clinical risk factors. Preoperative renal dysfunction (RD) was common among CABG patients, with 51% having mild RD (GFR 60 to 90 mL/min per 1.73 m², excludes dialysis), 24% moderate RD (GFR 30 to 59 mL/min per 1.73 m², excludes dialysis), 2% severe RD (GFR <30 mL/min per 1.73 m², excludes dialysis), and 1.5% requiring dialysis. Operative mortality rose inversely with declining renal function, from 1.3% for those with normal renal function to 9.3% for patients with severe RD not on dialysis and 9.0% for those who were dialysis dependent. After adjustment for other covariates, preoperative GFR was one of the most powerful predictors of operative mortality and morbidities.

Conclusions— Preoperative RD is common in the CABG population and carries important prognostic importance. Assessment of preoperative renal function should be incorporated into clinical risk assessment and prediction models.

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