Document Detail

Risk index for perioperative renal dysfunction/failure: critical dependence on pulse pressure hypertension.
MedLine Citation:
PMID:  17283267     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: An acute renal event after coronary bypass graft surgery is associated with high mortality and substantial additive cost. METHODS AND RESULTS: This prospective and descriptive study of 4801 patients having coronary bypass graft surgery with cardiopulmonary bypass from November 1996 to June 2000 at 70 centers in 16 countries established associations between predictor variables and postoperative renal composite (renal dysfunction and/or renal failure) from a cohort of 2381 patients and developed a risk index assessed in a validation cohort of 2420 patients. Postoperative renal composite occurred in 231 patients (4.8%). Independent and significant risk factors were age >75 years (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.23 to 3.37; P=0.006), preoperative congestive heart failure (OR, 2.38; CI, 1.55 to 3.64; P<0.001), prior myocardial infarction (OR, 1.75; CI, 1.08 to 2.83; P=0.023), preexisting renal disease (OR, 3.71; CI, 2.41 to 5.70; P<0.001), intraoperative multiple inotrope use (OR, 2.75; CI, 1.75 to 4.31; P<0.001), intraoperative intra-aortic balloon pump insertion (OR, 4.41; CI, 2.21 to 8.80; P<0.001), cardiopulmonary bypass >2 hours (OR, 1.78; CI, 1.15 to 2.74; P=0.01), and preoperative pulse pressure such that for every additional 20-mm Hg increment in pulse pressure >40 mm Hg, there was an OR of 1.49 (CI, 1.17 to 1.89; P=0.001). Patients with pulse pressure hypertension >80 mm Hg were 3 times more likely to die a renal-related death compared with those without (3.7% versus 1.1%). CONCLUSIONS: Beside established risk factors, pulse pressure is independently and significantly associated with increased renal composite.
Solomon Aronson; Manuel L Fontes; Yinghui Miao; Dennis T Mangano; ;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-02-05
Journal Detail:
Title:  Circulation     Volume:  115     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-13     Completed Date:  2007-03-12     Revised Date:  2007-08-30    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  733-42     Citation Subset:  AIM; IM    
Duke University Medical Center, Durham, NC, USA.
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MeSH Terms
Cardiopulmonary Bypass
Coronary Artery Bypass / adverse effects*,  economics
Health Care Costs
Hypertension / complications*,  physiopathology
Kidney Failure / epidemiology,  etiology*
Middle Aged
Prospective Studies
Pulsatile Flow
Risk Factors
Comment In:
Circulation. 2007 Jul 31;116(5):e119; author reply e120   [PMID:  17664381 ]

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