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(Circulation. 1997;95:878-884.)
© 1997 American Heart Association, Inc.
Articles |
Preoperative Renal Risk Stratification
the Renal Section, Medical Service (G.M.C.), and Health Services Research and Development (J.D.), Brockton-West Roxbury Department of Veteran Affairs Medical Center; Renal Division (G.M.C., J.M.L.) and Section for Clinical Epidemiology (E.F.C.), Department of Medicine, Brigham and Women's Hospital; Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Hospital (J.D.); Department of Health Care Policy, Harvard Medical School (C.L.C.), and Department of Epidemiology (E.F.C.), Harvard School of Public Health, Boston, Mass; and Division of Cardiology, Medical Service (K.E.H.), and Division of Cardiothoracic Surgery, Surgery Service (F.G.), Denver Department of Veterans Affairs Medical Center, University of Colorado Health Sciences Center, Denver.
Correspondence to Glenn M. Chertow, MD, MPH, Dialysis Unit Administrative Office, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail gmchertow@bics.bwh.harvard.edu.
Background After cardiac surgery, acute renal failure (ARF) requiring dialysis develops in 1% to 5% of patients and is strongly associated with perioperative morbidity and mortality. Prior studies have attempted to identify predictors of ARF but have had insufficient power to perform multivariable analyses or to develop risk stratification algorithms.
Methods and Results We conducted a prospective cohort study of 43 642 patients who underwent coronary artery bypass or valvular heart surgery in 43 Department of Veterans Affairs medical centers between April 1987 and March 1994. Logistic regression analysis was used to identify independent predictors of ARF requiring dialysis. A risk stratification algorithm derived from recursive partitioning was constructed and was validated on an independent sample of 3795 patients operated on between April and December 1994. The overall risk of ARF requiring dialysis was 1.1%. Thirty-day mortality in patients with ARF was 63.7%, compared with 4.3% in patients without ARF. Ten clinical variables related to baseline cardiovascular disease and renal function were independently associated with the risk of ARF. A risk stratification algorithm partitioned patients into low-risk (0.4%), medium-risk (0.9% to 2.8%), and high-risk (
5.0%) groups on the basis of several of these factors and their interactions.
Conclusions The risk of ARF after cardiac surgery can be accurately quantified on the basis of readily available preoperative data. These findings may be used by physicians and surgeons to provide patients with improved risk estimates and to target high-risk subgroups for interventions aimed at reducing the risk and ameliorating the consequences of this serious complication.
Key Words: kidney • epidemiology • cardiovascular diseases
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S. Garwood Renal Insufficiency After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 227 - 241. [Abstract] [PDF]
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P. E. Antunes, D. Prieto, J. F. de Oliveira, and M. J. Antunes Renal dysfunction after myocardial revascularization Eur. J. Cardiothorac. Surg., April 1, 2004; 25(4): 597 - 604. [Abstract] [Full Text] [PDF]
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J. Bucerius, J. F. Gummert, T. Walther, D. V. Schmitt, N. Doll, V. Falk, and F. W. Mohr On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy Ann. Thorac. Surg., April 1, 2004; 77(4): 1250 - 1256. [Abstract] [Full Text] [PDF]
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J. W. Hammon Risk Factors for Cardiac Surgery: The High-Risk Patient Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2004; 8(1): 15 - 17. [Abstract] [PDF]
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M. I. Stallwood, A. D. Grayson, K. Mills, and N. D. Scawn Acute renal failure in coronary artery bypass surgery: independent effect of cardiopulmonary bypass Ann. Thorac. Surg., March 1, 2004; 77(3): 968 - 972. [Abstract] [Full Text] [PDF]
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A. S. Michalopoulos, S. Geroulanos, and S. D. Mentzelopoulos Determinants of Candidemia and Candidemia-Related Death in Cardiothoracic ICU Patients Chest, December 1, 2003; 124(6): 2244 - 2255. [Abstract] [Full Text] [PDF]
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J. Boldt, T. Brenner, J. Lang, B. Kumle, and F. Isgro Kidney-Specific Proteins in Elderly Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass Anesth. Analg., December 1, 2003; 97(6): 1582 - 1589. [Abstract] [Full Text] [PDF]
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M. S. Maurer Age: a nonmodifiable risk factor? J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1427 - 1428. [Full Text] [PDF]
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M. Gaudino, A. Di Castelnuovo, R. Zamparelli, F. Andreotti, F. Burzotta, L. Iacoviello, F. Glieca, F. Alessandrini, G. Nasso, M. B. Donati, et al. Genetic control of postoperative systemic inflammatory reaction and pulmonary and renal complications after coronary artery surgery J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 1107 - 1112. [Abstract] [Full Text] [PDF]
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M. Swaminathan, B. G. Phillips-Bute, P. J. Conlon, P. K. Smith, M. F. Newman, and M. Stafford-Smith The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery Ann. Thorac. Surg., September 1, 2003; 76(3): 784 - 791. [Abstract] [Full Text] [PDF]
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D. N. Reddan, L. A. Szczech, R. H. Tuttle, L. K. Shaw, R. H. Jones, S. J. Schwab, M. S. Smith, R. M. Califf, D. B. Mark, and W. F. Owen Jr. Chronic Kidney Disease, Mortality, and Treatment Strategies among Patients with Clinically Significant Coronary Artery Disease J. Am. Soc. Nephrol., September 1, 2003; 14(9): 2373 - 2380. [Abstract] [Full Text] [PDF]
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A. D. Grayson, M. Khater, M. Jackson, and M. A. Fox Valvular heart operation is an independent risk factor for acute renal failure Ann. Thorac. Surg., June 1, 2003; 75(6): 1829 - 1835. [Abstract] [Full Text] [PDF]
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S. Provenchere, G. Plantefeve, G. Hufnagel, E. Vicaut, C. de Vaumas, J.-B. Lecharny, J.-P. Depoix, F. Vrtovsnik, J.-M. Desmonts, and I. Philip Renal Dysfunction After Cardiac Surgery with Normothermic Cardiopulmonary Bypass: Incidence, Risk Factors, and Effect on Clinical Outcome Anesth. Analg., May 1, 2003; 96(5): 1258 - 1264. [Abstract] [Full Text] [PDF]
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D. N. Wijeysundera, V. Rao, W. S. Beattie, J. Ivanov, and K. Karkouti Evaluating Surrogate Measures of Renal Dysfunction After Cardiac Surgery Anesth. Analg., May 1, 2003; 96(5): 1265 - 1273. [Abstract] [Full Text] [PDF]
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 N. Van Den Noortgate, V. Mouton, C. Lamot, G. Van Nooten, A. Dhondt, R. Vanholder, M. Afschrift, and N. Lameire Outcome in a post-cardiac surgery population with acute renal failure requiring dialysis: does age make a difference? Nephrol. Dial. Transplant., April 1, 2003; 18(4): 732 - 736. [Abstract] [Full Text] [PDF]
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 S Al-Ruzzeh, G Asimakopoulos, G Ambler, R Omar, R Hasan, B Fabri, A El-Gamel, A DeSouza, V Zamvar, S Griffin, et al. Validation of four different risk stratification systems in patients undergoing off-pump coronary artery bypass surgery: a UK multicentre analysis of 2223 patients Heart, April 1, 2003; 89(4): 432 - 435. [Abstract] [Full Text] [PDF]
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E. A.J. Hoste, N. H. Lameire, R. C. Vanholder, D. D. Benoit, J. M.A. Decruyenaere, and F. A. Colardyn Acute Renal Failure in Patients with Sepsis in a Surgical ICU: Predictive Factors, Incidence, Comorbidity, and Outcome J. Am. Soc. Nephrol., April 1, 2003; 14(4): 1022 - 1030. [Abstract] [Full Text] [PDF]
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P. A. McCullough Why is chronic kidney disease the "spoiler" for cardiovascular outcomes? J. Am. Coll. Cardiol., March 5, 2003; 41(5): 725 - 728. [Full Text] [PDF]
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B. J. McCreath, M. Swaminathan, J. V. Booth, B. Phillips-Bute, S. T.H. Chew, D. D. Glower, and M. Stafford-Smith Mitral valve surgery and acute renal injury: port access versus median sternotomy Ann. Thorac. Surg., March 1, 2003; 75(3): 812 - 819. [Abstract] [Full Text] [PDF]
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I. Durmaz, T. Yagdi, T. Calkavur, R. Mahmudov, A. Z. Apaydin, H. Posacioglu, Y. Atay, and C. Engin Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery Ann. Thorac. Surg., March 1, 2003; 75(3): 859 - 864. [Abstract] [Full Text] [PDF]
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C. S. Rinder, M. Fontes, J. P. Mathew, H. M. Rinder, and B. R. Smith Neutrophil CD11b upregulation during cardiopulmonary bypass is associated with postoperative renal injury Ann. Thorac. Surg., March 1, 2003; 75(3): 899 - 905. [Abstract] [Full Text] [PDF]
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J. Boldt, T. Brenner, A. Lehmann, S. W. Suttner, B. Kumle, and F. Isgro Is kidney function altered by the duration of cardiopulmonary bypass? Ann. Thorac. Surg., March 1, 2003; 75(3): 906 - 912. [Abstract] [Full Text] [PDF]
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M. J. Albahrani, M. Swaminathan, B. Phillips-Bute, P. K. Smith, M. F. Newman, J. P. Mathew, and M. Stafford-Smith Postcardiac Surgery Complications: Association of Acute Renal Dysfunction and Atrial Fibrillation Anesth. Analg., March 1, 2003; 96(3): 637 - 643. [Abstract] [Full Text] [PDF]
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B. O. Eriksen, K. R. S. Hoff, and S. Solberg Prediction of acute renal failure after cardiac surgery: retrospective cross-validation of a clinical algorithm Nephrol. Dial. Transplant., January 1, 2003; 18(1): 77 - 81. [Abstract] [Full Text] [PDF]
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M. A. Albert and E. M. Antman Preoperative Evaluation for Cardiac Surgery Card. Surg. Adult, January 1, 2003; 2(2003): 235 - 248. [Full Text]
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J. W. Hammon Jr. and L. H. Edmunds Jr. Extracorporeal Circulation: Organ Damage Card. Surg. Adult, January 1, 2003; 2(2003): 361 - 388. [Full Text]
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U. M Fischer, W. K Weissenberger, R D. Warters, H. J Geissler, S. J Allen, and U. Mehlhorn Impact of cardiopulmonary bypass management on postcardiac surgery renal function Perfusion, December 1, 2002; 17(6): 401 - 406. [Abstract] [PDF]
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