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Acute kidney injury after coronary artery bypass grafting surgery: predictors and survival impact
Session:
CO - Prémio Machado Macedo
Speaker:
Raquel Moreira
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Raquel Moreira; Francisca Saraiva; Ana Filipa Ferreira; Rui Cerqueira; Mário Jorge Amorim; Paulo Pinho; André Lourenço; Adelino Leite-Moreira
Abstract
<p><strong>Introduction</strong>: Cardiac surgery could induce acute kidney injury (AKI) and need for renal replacement therapy being the second most common cause of AKI in the intensive care unit.</p> <p><strong>Purpose</strong>: To determine AKI incidence after coronary artery bypass grafting (CABG) surgery, its predictors and its impact in immediate and long-term survival.</p> <p><strong>Methods</strong>: Retrospective single-center cohort study including all CABG surgeries performed in 2012 and 2013. Preoperative hemodialysis patients were excluded. AKI was defined as an increase of at least 0.3 mg/dL in creatinine within 48 hours, or an increase to 1.5 times or more from baseline, within 7 days after CABG. Chi-square tests and independent t-tests were used to compare categorical and continuous data, respectively, between patients with and without AKI. A multivariate logistic regression model was used to identify independent risk factors of AKI. To determine the effect of AKI in long-term survival, Kaplan-Meier curves, Log Rank test and multivariate Cox regression (maximum follow-up time: 6 years) were used.</p> <p><strong>Results</strong>: We included 809 patients, mean age 64±10 years, 82% being male. AKI occurred in 88 patients (11%). These patients were older (67±10 vs. 64±10 years, p=0.005), presented more frequently diabetes (51% vs. 38%, p=0.021), NYHA functional class III-IV (13% vs. 6%, p=0.031) and had worse renal function pre-operatively, characterised by a lower creatinine clearance (84±34 vs. 94±33 ml/min, p=0.007) compared with patients without AKI. In multivariate analysis, the occurrence of recent acute myocardial infarction (OR: 1.61, 95% CI: 1.01-2.59, p=0.048), obesity (OR: 1.70, 95% CI: 1.01-2.86, p=0.044), male gender (OR: 2.60, 95% CI: 1.28-5.29, p=0.008) and chronic kidney disease (CKD, CC< 85 ml/min, OR: 1.83, 95% CI:1.04-3.20, p=0.035) emerged as independent predictors of AKI. There were no significant differences in hospital mortality between groups (2.3% vs. 0.7%, p=0.133). Regarding long-term survival, patients with AKI did not show differences in cumulative survival compared to patients without AKI (87% vs. 90%, Log-rank test p=0.194). AKI was not an independent predictor of mortality in multivariate Cox regression (HR: 1.08, 95% CI: 0.56-2.10, p=0.820).</p> <p><strong>Conclusion</strong>: At our center AKI incidence after CABG surgery was 11%. Recent AMI, obesity, male gender and CKD were settled as AKI independent predictors. However, this immediate post-CABG outcome did not show association with long-term survival.</p>
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