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J Thorac Cardiovasc Surg. 2014 Mar;147(3):989-95. doi: 10.1016/j.jtcvs.2013.03.016. Epub 2013 Apr 12.

The impact of acute kidney injury on midterm outcomes after coronary artery bypass graft surgery: a matched propensity score analysis.

Author information

  • 1Renal and Cardiac Directorate, Barts and the London National Health Service Trust, London, England; William Harvey Research Institute, Queen Mary and Westfield University, London, England; National Institute for Health Research Cardiovascular Biomedical Research Unit, London Chest Hospital, London, England.
  • 2Renal and Cardiac Directorate, Barts and the London National Health Service Trust, London, England; National Institute for Health Research Cardiovascular Biomedical Research Unit, London Chest Hospital, London, England.
  • 3Renal and Cardiac Directorate, Barts and the London National Health Service Trust, London, England.
  • 4Renal and Cardiac Directorate, Barts and the London National Health Service Trust, London, England; William Harvey Research Institute, Queen Mary and Westfield University, London, England; National Institute for Health Research Cardiovascular Biomedical Research Unit, London Chest Hospital, London, England. Electronic address: m.m.yaqoob@qmul.ac.uk.

Abstract

BACKGROUND:

The development of acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery is associated with increased short- and long-term mortality. Whether AKI has a causal relationship with subsequent mortality or whether the development of AKI simply occurs in patients with more comorbidity undergoing more complex procedures remains unresolved.

METHODS AND RESULTS:

This was an observational cohort study of prospectively collected data from 4694 patients discharged from the hospital after first-time CABG surgery at a tertiary cardiac center between 2003 and 2008. AKI was defined using the Risk, Injury, Failure, Loss, and End stage (RIFLE) criteria, which require at least a 50% increase in serum creatinine. The primary outcome measure was all-cause mortality determined via UK Office of National Statistics. A total of 562 (12.0%) of patients developed AKI after CABG surgery. Patients who developed AKI were older, more likely to be female, and had more comorbidity than patients who did not develop AKI. In a Cox multivariable analysis, the development of AKI was an independent predictor of midterm mortality (hazard ratio, 1.80; 95% confidence interval, 1.50-2.16). Subsequently, a comparison of 562 patients who sustained AKI with 562 propensity score-matched patients who did not sustain AKI was undertaken. After propensity matching, baseline clinical and operative characteristics were similar between both groups. After Cox multivariable analysis of the propensity-matched cohort, AKI remained an independent predictor of midterm mortality (hazard ratio, 1.52; 95% confidence interval, 1.19-1.93).

CONCLUSIONS:

The development of AKI after CABG is a serious event associated with worse midterm survival. This excess mortality cannot be explained simply by coexisting comorbidity and surgical complexity.

Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
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