Preoperative estimated glomerular filtration rate

Authors: Satoru Domoto Osamu Tagusari Yoshitsugu Nakamura Hideaki Takai Yoshimasa Seike Yujiro Ito Yuko Shibuya Fumiaki Shikata

Publish Date: 2013/08/15

Volume: 62, Issue: 2, Pages: 95-102

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Abstract

The aim of this retrospective study was to investigate the effect of chronic kidney disease CKD on outcomes after coronary artery bypass grafting CABG and to determine whether preoperative estimated glomerular filtration rate eGFR can be a predictor of longterm outcomes after CABG486 Japanese patients who underwent isolated CABG between December 2000 and August 2010 were evaluated Preoperative eGFR was estimated by the Japanese equation according to guidelines from the Japanese Society of Nephrology We defined CKD as a preoperative eGFR of less than 60 ml/min/173 m2 203 patients had CKD CK group and 283 patients did not N groupDuring a mean observation time of 53 months the overall survival rate was significantly lower in the CK group than in the N group p = 00044 Similarly the CK group had significantly more unfavorable results with regard to freedom from cardiac death major adverse cardiovascular and cerebrovascular events MACCE and hemodialysis Using multivariate analyses preoperative eGFR was an independent predictor of allcause mortality HR 0983 p = 0026 cardiac mortality HR 0963 p = 0006 and incidence of MACCE HR 0983 p = 0002Severe renal dysfunction in particular which requires dialysis has been identified as a risk factor for adverse outcomes after coronary artery bypass grafting CABG 1 2 3 Chronic kidney disease CKD that does not require dialysis which has been defined according to levels of serum creatinine or estimated glomerular filtration rate eGFR calculated by the Cockcroft–Gault equation has also been identified as a predictor of poor outcomes after CABG 4 5 6 7 8 9 10 11 It has been reported recently that eGFR calculated using the Modification of Diet in Renal Disease MDRD study equation is a more accurate marker of renal function than either creatinine clearance or eGFR calculated by the Cockroft–Gault equation Thus the calculation of eGFR in this way could aid in the diagnosis of mild renal impairment even in patients with normal or nearly normal creatinine levels 12 A limited number of studies have defined CKD according to eGFR calculated using the MDRD study equation assessed the impact of CKD on longterm outcomes after CABG and determined whether preoperative eGFR is a predictor of longterm outcomes after CABG 13 14 15 It has been also reported that the revised Japanese equation is more accurate for the Japanese population than the MDRD study equation using the previous Japanese Society of Nephrology Chronic Kidney Disease Initiative 16 In this study we calculated eGFR and defined CKD using the Japanese equation according to guidelines from the Japanese Society of Nephrology The aim of this retrospective study was to investigate the effect of CKD on early and longterm outcomes after CABG in Japanese patients and to determine whether preoperative eGFR is a predictor of longterm outcomes after CABGWe defined CKD as a preoperative eGFR of less than 60 ml/min/173 m2 according to guidelines from the National Kidney Foundation 17 18 19 eGFR was calculated using the Japanese equitation according to guidelines from the Japanese Society of Nephrology 16 eGFR ml/min/173 m2 = 194 × serum creatinine mg/dl−1094 × age years−0287 × 0739 in the case of female patients Note that all our patients were Japanese Preoperative eGFR was calculated at admissionThe end points studied overall death cardiac death incidence of major adverse cardiovascular and cerebrovascular events MACCE and introduction to HD Cardiac death included deaths caused by myocardial infarction heart failure or sudden death Followup information was obtained from each patient’s hospital records interviews at the time of outpatient visit telephone calls and from referring physicians

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