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Mild renal dysfunction predicts in-hospital mortality and post-discharge survival following cardiac surgery

^a Department of Cardiothoracic Surgery, University Hospital Birmingham, UK
^b University of Birmingham, Birmingham, UK
^c National Institute for Clinical Outcomes Research, University College London, UK

Received 3 September 2007; received in revised form 15 April 2008; accepted 21 April 2008.

^_* Corresponding author. Address: Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham B15 2TH, UK. Tel.: +44 121 627 2850; fax: +44 121 627 2895. (Email: domenico.pagano{at}uhb.nhs.uk).

Objectives: To assess the impact of preoperative renal dysfunction on in-hospital mortality and late survival outcome following adult cardiac surgery. Methods: Prospectively collected data were analysed on 7621 consecutive patients not requiring preoperative renal-replacement therapy, who underwent CABG, valve surgery or combined procedures from 1/1/98 to 1/12/06. Preoperative estimated glomerular filtration rate was calculated using Cockcroft-Gault formula. Patients were classified in the four chronic kidney disease (CKD) stage classes defined by the National Kidney Foundation Disease Outcome Quality Initiative Advisory Board. Late survival data were obtained from the UK Central Cardiac Audit Database. Results: There were 243 in-hospital deaths (3.2%). There was a stepwise increase in operative mortality with each CKD class independent of the type of surgery. Multivariate analysis confirmed CKD class to be an independent predictor of in-hospital mortality (class 2 OR 1.45, 95% CI 1.1–2.35, p = 0.001; class 3 OR 2.8, 95% CI 1.68–4.46, p = 0.0001; class 4 OR 7.5, 95% CI 3.76–15.2, p = 0.0001). The median follow-up after surgery was 42 months (IQR 18–74) and there were 728 late deaths. Survival analysis using a Cox regression model confirmed CKD class to be an independent predictor of late survival (class 2 HR 1.2, 95% CI 1.1–1.6, p = 0.0001; class 3 HR 1.95, 95% CI 1.6–2.4, p = 0.0001; and class 4 HR 3.2, 95% CI 2.2–4.6, p = 0.0001). Ninety-eight percent (7517/7621) of patients had a preoperative creatinine <200 µmol/l, which is not included as a risk factor in most risk stratification systems. Conclusions: Mild renal dysfunction is an important independent predictor of in-hospital and late mortality in adult patients undergoing cardiac surgery.

Key Words: Cardiac surgery • Renal dysfunction • Survival analysis

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