Preoperative Chronic Kidney Disease as a Strong Predictor of Postoperative Infection and Mortality After Coronary Artery Bypass Grafting

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概要

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• Background:The aim of this study was to determine the influence of preoperative kidney dysfunction (ie, chronic kidney disease (CKD)) on postoperative cardiovascular events, infection, acute kidney injury and hospital mortality in patients undergoing coronary artery bypass grafting (CABG).Methods and Results:A multi-institutional retrospective study was performed at 14 hospitals of adult patients undergoing isolated CABG from 2007 to 2008 (n=1,522). We classified CKD level according to preoperative estimated glomerular filtration rate (eGFR): normal, eGFR >90 ml·min–1·1.73 m–2; mild, eGFR 60–90 ml·min–1·1.73 m–2; moderate, eGFR 30–59 ml·min–1·1.73 m–2; and severe, eGFR <30 ml·min–1·1.73 m–2, and assessed postoperative outcome. Preoperative CKD distribution was as follows: normal, n=121 (8%); mild, n=713 (47%); moderate, n=515 (34%); and severe, n=169 (11%). Risk of infection was strongly correlated with CKD level (normal, 3.3%; mild, 7.0%; moderate, 8.3%; severe, 17.0%; P<0.01). The risk of in-hospital death was also strongly correlated with CKD level (normal, 1.7%; mild, 1.0%; moderate, 1.6%; severe, 5.9%; P<0.01). On multivariate logistic regression analysis, CKD level was identified as a significant risk factor for postoperative infection, acute kidney injury, and in-hospital death.Conclusions:Advanced preoperative CKD is a strong predictor of postoperative infection, acute kidney injury and in-hospital death after CABG. (Circ J 2014; 78: 2225–2231)

• 一般社団法人 日本循環器学会の論文

著者

• Miyamoto Yoshihiro

  National Cardiovascular Center

• UESHIMA Kenji

  Kyoto University Graduate School of Medicine

• YASUNO Shinji

  Kyoto University Graduate School of Medicine

• TAKANASHI Shuichiro

  Sakakibara Heart Institute

• TANEMOTO Kazuo

  Kawasaki Medical School, Department of Cardiovascular Surgery Kurashiki

• Masuda Izuru

  Takeda Hospital Medical Examination Center

• Ueda Yuichi

  Nara Prefectural Hospital

• Bando Ko

  Jikei University School of Medicine

• Arinaga Koichi

  Kurume University School of Medicine

• Konishi Hiroaki

  Jichi Medical University

• Minakata Kenji

  Kyoto University Graduate School of Medicine

• Tanaka Shiro

  Kyoto University School of Public Health

• Okita Yutaka

  Kobe University Graduate School of Medicine

• Okabayashi Hitoshi

  Iwate Medical University

• Yaku Hitoshi

  Kyoto Prefectural University of Medicine

• Okamura Yoshitaka

  Wakayama Medical University

• Hisashi Yosuke

  Kagoshima University Graduate School of Medicine and Dental Science

• Sakata Ryuzo

  Kyoto University Graduate School of Medicine

• Tanemoto Kazuo

  Kawasaki Medical School

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