This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: May 12, 2009, Volume 119, Number 18 All Versions of this Article: 119/18/2444    most recent CIRCULATIONAHA.108.800011v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hobson, C. E. Articles by Bihorac, A. Search for Related Content PubMed PubMed Citation Articles by Hobson, C. E. Articles by Bihorac, A. Related Collections CV surgery: aortic and vascular disease CV surgery: coronary artery disease CV surgery: valvular disease CV surgery: other Related Article

(Circulation. 2009;119:2444-2453.)
© 2009 American Heart Association, Inc.

Cardiovascular Surgery

Acute Kidney Injury Is Associated With Increased Long-Term Mortality After Cardiothoracic Surgery

Charles E. Hobson, MD; Sinan Yavas, MD; Mark S. Segal, MD, PhD; Jesse D. Schold, PhD; Curtis G. Tribble, MD; A. Joseph Layon, MD; Azra Bihorac, MD

From the Division of Thoracic and Cardiovascular Surgery (C.E.H., C.G.T.), Department of Surgery; Division of Critical Care Medicine (S.Y., A.J.L., A.B.), Department of Anesthesiology; and Division of Nephrology (M.S.S., J.D.S.), Hypertension and Transplantation, Department of Medicine, University of Florida College of Medicine, Gainesville, Fla.

Correspondence to Azra Bihorac, MD, FASN, Division of Critical Care Medicine, Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, 1600 SW Archer Rd, Gainesville, FL 32610-0286. E-mail abihorac{at}anest.ufl.edu

Received June 18, 2008; accepted February 23, 2009.

Background— Long-term survival after acute kidney injury (AKI) is poorly studied. We report the relationship between long-term mortality and AKI with small changes in serum creatinine during hospitalization after various cardiothoracic surgery procedures.

Methods and Results— This was a retrospective study of 2973 patients with no history of chronic kidney disease who were discharged from the hospital after cardiothoracic surgery between 1992 and 2002. AKI was defined by the RIFLE classification (Risk, Injury, Failure, Loss, and End stage), which requires at least a 50% increase in serum creatinine and stratifies patients into 3 grades of AKI: Risk, injury, and failure. Patient survival was determined through the National Social Security Death Index. Long-term survival was analyzed with a risk-adjusted Cox proportional hazards regression model. Survival was worse among patients with AKI and was proportional to its severity, with an adjusted hazard ratio of 1.23 (95% CI 1.06 to 1.42) for the least severe RIFLE risk class and 2.14 (95% CI 1.73 to 2.66) for the RIFLE failure class compared with patients without AKI. Survival was worse among all subgroups of cardiothoracic surgery with AKI except for valve surgery. Patients with complete renal recovery after AKI still had an increased adjusted hazard ratio for death of 1.28 (95% CI 1.11 to 1.48) compared with patients without AKI.

Conclusions— The risk of death associated with AKI after cardiothoracic surgery remains high for 10 years regardless of other risk factors, even for those patients with complete renal recovery. Improved renal protection and closer postdischarge follow-up of renal function may be warranted.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2009 119: 2417-2419. [Extract] [Full Text]