Document Detail

Effect of off-pump coronary artery bypass graft surgery on postoperative acute kidney injury and mortality.
MedLine Citation:
PMID:  17075372     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Risk of mortality after cardiac surgery is associated with severity of acute kidney injury. The aim of this study is to examine the effect of off-pump coronary artery bypass surgery on the risk of postoperative acute kidney injury and its association with mortality. DESIGN: Observational cohort study. SETTING: Tertiary care center. PATIENTS: Some 10,061 patients underwent coronary artery bypass surgery (1998-2002), of which 1,365 patients underwent off-pump surgery. INTERVENTIONS: Acute kidney injury was defined as either requirement of dialysis or >/=50% decline in postoperative glomerular filtration rate but not requiring dialysis. We compared on- and off-pump surgeries and used propensity score matching to examine the effect of off-pump surgery on acute kidney injury and mortality. MEASUREMENTS AND MAIN RESULTS: We found that 2.6% on-pump and 1.2% off-pump patients developed acute kidney injury requiring dialysis among the 2,370 matched subjects (relative risk, 2.06; 95% confidence interval [CI], 1.36-3.36); 5.0% of on-pump patients suffered a >/=50% decline in glomerular filtration rate compared with 2.5% in off-pump group (relative risk, 2.00; 95% CI, 1.48-2.82). The mortality rate in the matched cohort was 2.3% for on-pump group vs. 0.6% in off-pump group (relative risk, 3.88; 95% CI, 2.29-9.50). Among matched patients with acute kidney injury, the risk of mortality was 13.14 (95% CI, 8.43-30.50) in patients requiring dialysis and 9.33 (95% CI, 4.83-19.00) in those with >/=50% decline in glomerular filtration rate but not requiring dialysis. CONCLUSIONS: Off-pump surgery is associated with a lower risk of developing acute kidney injury (regardless of its definition). The risk of mortality is incremental with worsening degrees of acute kidney injury. Lower risk of acute kidney injury may be one of the factors that offer a survival advantage after off-pump surgery.
John Kevin Hix; Charuhas V Thakar; Ethan M Katz; Jean-Pierre Yared; Joseph Sabik; Emil P Paganini
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  34     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-28     Completed Date:  2006-12-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2979-83     Citation Subset:  AIM; IM    
Departments of Nephrology and Hypertension, Cleveland Clinic Foundation, Cleveland, OH, USA.
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MeSH Terms
Cohort Studies
Coronary Artery Bypass / adverse effects,  methods*,  mortality*
Creatinine / blood
Glomerular Filtration Rate
Kidney Failure, Acute / etiology,  mortality*,  prevention & control*
Risk Factors
Reg. No./Substance:
Comment In:
Crit Care Med. 2006 Dec;34(12):3052-3   [PMID:  17130705 ]

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