Comparison of Accuracy of Different Renal Function Measurements for Predicting Adverse Events after Off-pump Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU Zhan , XIAO Feng.

Department of Cardiac Surgery，the First Hospital of PekingUniversity，Beijing 100034，P. R. China;

Corresponding author：

Keywords：

Coronary artery bypass grafting; Renal dysfunction; Glomerular filtration rate

DOI：

10.7507/1007-4848.20130165

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Objective To compare the accuracy of different renal function measurements for predicting postoperativeadverse events after off-pump coronary artery bypass grafting （OPCAB） for Chinese patients. Methods Clinical data of 283 Chinese patients undergoing isolated OPCAB from January 2010 to December 2011 in the First Hospital of Peking University were retrospectively analyzed. There were 194 male and 89 female patients with their age of 65.0±9.7 years. Estimated glomerular filtration rate （eGFR） was calculated using Cockcroft-Gault equation，Modification of Diet in Renal Disease （MDRD） study equation and Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation respectively.Logistic multivariate regression analysis was performed to compare the accuracy of these 3 different renal function measure-ments for predicting postoperative adverse events. Results Logistic multivariate regression analysis showed that preoper-ative renal dysfunction was an independent risk factor for higher postoperative morbidity，more blood transfusion，prolongedhospitalization，mechanical ventilation time and length of ICU stay. Among the different postoperative complications，preop-erative renal dysfunction was an independent risk factor for postoperative acute renal injury，gastrointestinal bleeding，new onset atrial fibrillation and low cardiac output syndrome. Among Cockcroft-Gault equation，MDRD study equationand CKD-EPI equation to calculate eGFR，CKD-EPI equation was most accurate to predict postoperative morbidity （OR=1.227），acute renal injury （OR=1.534），new onset atrial fibrillation （OR=1.184），prolonged hospitalization（OR=1.160），mechanical ventilation time （OR=1.165） and ICU stay （OR=1.151）. Conclusion Preoperative renal dysfunction is an independent risk factor for postoperative adverse events after OPCAB. CKD-EPI equation is more suitable for predicting postoperative adverse events after OPCAB for Chinese patients.

Citation： HU Zhan,XIAO Feng.. Comparison of Accuracy of Different Renal Function Measurements for Predicting Adverse Events after Off-pump Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(5): 518-523. doi: 10.7507/1007-4848.20130165 Copy

1.	Lin Y， Zheng Z， Li Y， et al. Impact of renal dysfunction on long-termsurvival after isolated coronary artery bypass surgery. Ann Thorac Surg， 2009， 87 （4）：1079-1084.
2.	Cooper WA， O′Brien SM， Thourani VH， et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery：results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation， 2006， 113 （8）：1063-1070.
3.	Noyez L， Plesiewicz I， Verheugt FW. Estimated creatinine clearanceinstead of plasma creatinine level as prognostic test for postoperative renal function in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg， 2006， 29 （4）：461-465.
4.	Wijeysundera DN， Karkouti K， Beattie WS， et al. Improving the identification of patients at risk of postoperative renal failure after cardiac surgery. Anesthesiology， 2006， 104 （1）：65-72.
5.	Weerasinghe A， Hornick P， Smith P， et al. Coronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction. J Thorac Cardiovasc Surg， 2001， 121 （6）：1083-1089.
6.	Filsoufi F， Rahmanian PB， Castillo JG， et al. Early and late outcomesof cardiac surgery in patients with moderate to severe preoperative renal dysfunction without dialysis. Interact Cardiovasc Thorac Surg， 2008， 7 （1）：90-95.
7.	Sajja LR， Mannam G， Chakravarthi RM， et al. Impact of preoperativerenal dysfunction on outcomes of off-pump coronary artery bypass grafting. Ann Thorac Surg， 2011， 92 （6）：2161-2167.
8.	Holzmann MJ， Ahlbäck E， Jeppsson A， et al. Renal dysfunctionand long-term risk of ischemic and hemorrhagic stroke followingcoronary arterybypass grafting.Int J Cardiol， 2012， 5273 （12）：1565-1563.
9.	Reddan DN， Szczech LA， Tuttle RH， et al. Chronic kidney disease， mortality， and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol， 2003， 14 （9）：2373-2380.
10.	Hillis LD， Smith PK， Anderson JL， et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the AmericanCollege of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for thoracic surgery， society of cardiovascularanesthesiologists， and society of thoracic surgeons. J Am Coll Cardiol，2011， 58 （24）：e123-e210.
11.	Nigwekar SU， Kandula P， Hix JK， et al. Off-pump coronary artery bypass surgery and acute kidney injury：a meta-analysis of randomized and observational studies. Am J Kidney Dis， 2009， 54 （3）：413-423.
12.	Sajja LR， Mannam G， Chakravarthi RM， et al. Coronary arterybypass grafting with or without cardiopulmonary bypass in patients with preoperative non–dialysis dependent renal insufficiency：A rando-mized study. J Thoracic Cardiovasc Surg， 2007， 133 （2）：378-388.
13.	Di Mauro M， Gagliardi M， Iacò AL， et al. Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function. Ann Thorac Surg， 2007， 84 （5）：1496-1502.
14.	Abu-Omar Y， Taghavi FJ， Navaratnarajah M， et al. The impact of off-pump coronary artery bypass surgery on postoperative renal function. Perfusion， 2012， 27 （2）：127-131.
15.	Chawla LS， Zhao Y， Lough FC， et al. Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol， 2012， 23 （8）：1389-1397.
16.	Boulton BJ， Kilgo P， Guyton RA， et al. Impact of preoperativerenal dysfunction in patients undergoing off-pump versus on-pumpcoronary artery bypass. Ann Thorac Surg， 2011， 92 （2）：595-601.
17.	Cockcroft DW， Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron， 1976， 16 （1）：31-41.
18.	Ma YC， Zuo L， Chen JH， et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol， 2006， 17 （10）：2937-2944.
19.	Levey AS， Stevens LA， Schmid CH， et al. A new equation to estimateglomerular filtration rate. Ann Intern Med， 2009， 150 （9）：604-612.
20.	Duncan L， Heathcote J， Djurdjev O， et al. Screening for renal disease using serum creatinine：who are we missing ? Nephrol Dial Transplant， 2001， 16 （5）：1042-1046.
21.	Swedko PJ， Clark HD， Paramsothy K， et al. Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med， 2003， 163 （3）：356-360.
22.	Eknoyan G， Levin NW. K/DOQI clinical practice guidelines for chronic kidney disease：evaluation， classification， and stratification. Am J Kidney Dis， 2002， 39 （2 Suppl 1）：S1-S266.
23.	Michels WM， Grootendorst DC， Verduijn M， et al. Performance of the cockcroft-gault， MDRD， and new CKD-EPI formulas in relation to GFR， age， and body size. Clin J Am Soc Nephrol， 2010， 5 （6）：1003-1009.
24.	van Straten AH， Soliman Hamad MA， Koene BM， et al. Which methodof estimating renal function is the best predictor of mortality after coronary artery bypassgrafting ? Neth Heart J， 2011， 19 （11）：464-469.
25.	Wang F， Dupuis JY， Nathan H， et al. An analysis of the associationbetween preoperative renal dysfunction and outcome in cardiacsurgery：estimated creatinine clearance or plasma creatinine level asmeasures of renal function. Chest， 2003， 124 （5）：1852-1862.
26.	Luciani R， Lazzarino AI， Capuano F， et al. Preoperative creatinine clearance as a predictor of short-term outcomes after cardiac surgery：a cohort study for the comparison between the Cockroft-Gault and modification of diet in renal disease formulae. J Cardiovasc Med （Hagerstown）， 2010， 11 （4）：271-275.
27.	Stevens LA， Coresh J， Feldman HI， et al. Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol， 2007， 18 （10）：2749-2757.
28.	Zakeri R， Freemantle N， Barnett V， et al. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation， 2005， 112 （9 Suppl）：270-275.
29.	Miceli A， Bruno VD， Capoun R， et al. Occult renal dysfunction：a mortality and morbidity risk factor in coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg， 2011， 141 （3）：771-776.

1. 　Lin Y， Zheng Z， Li Y， et al. Impact of renal dysfunction on long-termsurvival after isolated coronary artery bypass surgery. Ann Thorac Surg， 2009， 87 （4）：1079-1084.
2. 　Cooper WA， O′Brien SM， Thourani VH， et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery：results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation， 2006， 113 （8）：1063-1070.
3. 　Noyez L， Plesiewicz I， Verheugt FW. Estimated creatinine clearanceinstead of plasma creatinine level as prognostic test for postoperative renal function in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg， 2006， 29 （4）：461-465.
4. 　Wijeysundera DN， Karkouti K， Beattie WS， et al. Improving the identification of patients at risk of postoperative renal failure after cardiac surgery. Anesthesiology， 2006， 104 （1）：65-72.
5. 　Weerasinghe A， Hornick P， Smith P， et al. Coronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction. J Thorac Cardiovasc Surg， 2001， 121 （6）：1083-1089.
6. 　Filsoufi F， Rahmanian PB， Castillo JG， et al. Early and late outcomesof cardiac surgery in patients with moderate to severe preoperative renal dysfunction without dialysis. Interact Cardiovasc Thorac Surg， 2008， 7 （1）：90-95.
7. 　Sajja LR， Mannam G， Chakravarthi RM， et al. Impact of preoperativerenal dysfunction on outcomes of off-pump coronary artery bypass grafting. Ann Thorac Surg， 2011， 92 （6）：2161-2167.
8. 　Holzmann MJ， Ahlbäck E， Jeppsson A， et al. Renal dysfunctionand long-term risk of ischemic and hemorrhagic stroke followingcoronary arterybypass grafting.Int J Cardiol， 2012， 5273 （12）：1565-1563.
9. 　Reddan DN， Szczech LA， Tuttle RH， et al. Chronic kidney disease， mortality， and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol， 2003， 14 （9）：2373-2380.
10. 　Hillis LD， Smith PK， Anderson JL， et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the AmericanCollege of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for thoracic surgery， society of cardiovascularanesthesiologists， and society of thoracic surgeons. J Am Coll Cardiol，2011， 58 （24）：e123-e210.
11. 　Nigwekar SU， Kandula P， Hix JK， et al. Off-pump coronary artery bypass surgery and acute kidney injury：a meta-analysis of randomized and observational studies. Am J Kidney Dis， 2009， 54 （3）：413-423.
12. 　Sajja LR， Mannam G， Chakravarthi RM， et al. Coronary arterybypass grafting with or without cardiopulmonary bypass in patients with preoperative non–dialysis dependent renal insufficiency：A rando-mized study. J Thoracic Cardiovasc Surg， 2007， 133 （2）：378-388.
13. 　Di Mauro M， Gagliardi M， Iacò AL， et al. Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function. Ann Thorac Surg， 2007， 84 （5）：1496-1502.
14. 　Abu-Omar Y， Taghavi FJ， Navaratnarajah M， et al. The impact of off-pump coronary artery bypass surgery on postoperative renal function. Perfusion， 2012， 27 （2）：127-131.
15. 　Chawla LS， Zhao Y， Lough FC， et al. Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol， 2012， 23 （8）：1389-1397.
16. 　Boulton BJ， Kilgo P， Guyton RA， et al. Impact of preoperativerenal dysfunction in patients undergoing off-pump versus on-pumpcoronary artery bypass. Ann Thorac Surg， 2011， 92 （2）：595-601.
17. 　Cockcroft DW， Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron， 1976， 16 （1）：31-41.
18. 　Ma YC， Zuo L， Chen JH， et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol， 2006， 17 （10）：2937-2944.
19. 　Levey AS， Stevens LA， Schmid CH， et al. A new equation to estimateglomerular filtration rate. Ann Intern Med， 2009， 150 （9）：604-612.
20. 　Duncan L， Heathcote J， Djurdjev O， et al. Screening for renal disease using serum creatinine：who are we missing ? Nephrol Dial Transplant， 2001， 16 （5）：1042-1046.
21. 　Swedko PJ， Clark HD， Paramsothy K， et al. Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med， 2003， 163 （3）：356-360.
22. 　Eknoyan G， Levin NW. K/DOQI clinical practice guidelines for chronic kidney disease：evaluation， classification， and stratification. Am J Kidney Dis， 2002， 39 （2 Suppl 1）：S1-S266.
23. 　Michels WM， Grootendorst DC， Verduijn M， et al. Performance of the cockcroft-gault， MDRD， and new CKD-EPI formulas in relation to GFR， age， and body size. Clin J Am Soc Nephrol， 2010， 5 （6）：1003-1009.
24. 　van Straten AH， Soliman Hamad MA， Koene BM， et al. Which methodof estimating renal function is the best predictor of mortality after coronary artery bypassgrafting ? Neth Heart J， 2011， 19 （11）：464-469.
25. 　Wang F， Dupuis JY， Nathan H， et al. An analysis of the associationbetween preoperative renal dysfunction and outcome in cardiacsurgery：estimated creatinine clearance or plasma creatinine level asmeasures of renal function. Chest， 2003， 124 （5）：1852-1862.
26. 　Luciani R， Lazzarino AI， Capuano F， et al. Preoperative creatinine clearance as a predictor of short-term outcomes after cardiac surgery：a cohort study for the comparison between the Cockroft-Gault and modification of diet in renal disease formulae. J Cardiovasc Med （Hagerstown）， 2010， 11 （4）：271-275.
27. 　Stevens LA， Coresh J， Feldman HI， et al. Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol， 2007， 18 （10）：2749-2757.
28. 　Zakeri R， Freemantle N， Barnett V， et al. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation， 2005， 112 （9 Suppl）：270-275.
29. 　Miceli A， Bruno VD， Capoun R， et al. Occult renal dysfunction：a mortality and morbidity risk factor in coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg， 2011， 141 （3）：771-776.

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Comparison of Accuracy of Different Renal Function Measurements for Predicting Adverse Events after Off-pump Coronary Artery Bypass Grafting

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