Cardiac surgery in moderate to end-stage renal failure: analysis of risk factors

Ann Thorac Surg. 2002 Aug;74(2):378-83. doi: 10.1016/s0003-4975(02)03711-6.

Abstract

Background: The incremental surgical risk caused by different categories of renal failure is not well defined.

Methods: Data from 159 patients with moderate to end-stage renal dysfunction, who had consecutive operations using cardiopulmonary bypass, were included in a multivariate analysis of morbidity and survival. Ninety-nine patients had preoperative serum creatinine levels (PSCL) of 1.9 to 2.5 mg/dL (moderate), 36 had PSCL higher than 2.5 mg/dL and were not dialysis dependent (severe), and 24 required chronic dialysis (end-stage dysfunction).

Results: Operative mortality was 4% with moderate dysfunction and compared favorably with 16.7% in severe and 8% in end-stage dysfunction (p < 0.05). Independent predictors of death were severe non-dialysis-dependent renal dysfunction (p < 0.05), diabetes (p < 0.05), and cardiopulmonary bypass time (p < 0.01). Severe renal dysfunction (p < 0.01) and diabetes (p < 0.01) also predicted pulmonary and neurologic morbidity. Freedom from late death at 4 years was 82% +/- 5% with moderate, 49% +/- 10% with severe, and 60% +/- 10% with end-stage dysfunction (p < 0.01). Time to late death was adversely affected by severe (p < 0.05) and end-stage dysfunction (p < 0.01). Persistent improvement of symptoms was observed in all subgroups.

Conclusions: Satisfactory early and late surgical outcomes may be expected in patients with moderate renal failure, but outcomes are often poor with severe non-dialysis-dependent and end-stage renal dysfunction.

MeSH terms

  • Aged
  • Cardiac Surgical Procedures
  • Female
  • Heart Diseases / complications*
  • Heart Diseases / mortality
  • Heart Diseases / surgery*
  • Humans
  • Kidney Failure, Chronic / complications*
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate
  • Time Factors