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Original Articles: Adult Cardiac

Long-Term Survival After Cardiac Surgery is Predicted by Estimated Glomerular Filtration Rate

^a Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
^b Central Maine Medical Center, Lewiston, Maine
^c Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
^d Providence Health System, Portland, Oregon
^e Catholic Medical Center, Manchester, New Hampshire
^f Fletcher Allen Health Care, Portland
^g Portsmouth Regional Hospital, Portland
^h Maine Medical Center, Portland
ⁱ Eastern Maine Medical Center, Bangor, Maine
^j Concord Hospital, Concord, New Hampshire

Accepted for publication March 3, 2008.

^_* Address correspondence to Dr Brown, Rubin 505, Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Dr, Lebanon, NH 03756 (Email: jeremiah.r.brown{at}dartmouth.edu).

Background: Estimated glomerular filtration rate (eGFR) before coronary artery bypass graft (CABG) surgery is a key risk factor of in-hospital mortality. However, in patients with normal renal function before CABG, acute kidney injury develops after the procedure, making postoperative renal function assessment necessary for evaluation. Postoperative eGFR and its association with long-term survival have not been well studied.

Methods: We studied 13,593 consecutive CABG patients in northern New England from 2001 to 2006. Patients with preoperative dialysis were excluded. Data were linked to the Social Security Association Death Master File to assess long-term survival. Kaplan-Meier and log-rank techniques were used. Patients were stratified by established categories of postoperative eGFR (90 or greater, 60 to 89, 30 to 59, 15 to 29, and less than 15 mL · min^–1 · 1.73 m^–2).

Results: Median follow-up was 2.8 years (mean, 2.7; range, 0 to 5.5). Patients with moderate to severe acute kidney injury (less than 60) after CABG had significantly worse survival than patients with little or no acute kidney injury (90 or greater).

Conclusions: Patients having moderate to severe acute kidney injury after CABG surgery had worse 5-year survival compared with patients who had normal or near-normal renal function.

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				M. Stafford-Smith Invited commentary Ann. Thorac. Surg., July 1, 2008; 86(1): 11 - 12. [Full Text] [PDF]