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Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery

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Abstract

Purpose

Chronic kidney disease (CKD) and anemia are independent preoperative risk factors for coronary artery bypass graft (CABG) surgery. We evaluated the implications of the coexistence of these two factors and their associated prognosis for CABG surgery.

Methods

We analyzed, retrospectively, consecutive patients who underwent elective CABG surgery between 2004 and 2014. The patients were classified into four groups depending on the presence or absence of preoperative CKD and anemia. We assessed the major adverse cardiac and cerebrovascular event (MACCE), defined as composite outcomes of cardio- and cerebrovascular death, revascularization through surgery or percutaneous intervention, hospitalization for congestive heart failure, and cerebral infarction.

Results

The study population consisted of 510 patients (73 % male; median age 71 years old), followed up for a median period of 2.8 years. Multivariate analysis indicated that neither the CKD/no-anemia group [hazard ratio (HR) 0.98, 95 % confidence interval (CI) 0.39–2.51, P = 0.973] nor the no-CKD/anemia group (HR 1.20, 95 % CI 0.69–2.09, P = 0.512) had significantly poorer prognoses than the no-CKD/no-anemia group. However, the CKD/anemia group had a significantly higher risk of a MACCE (HR 2.01, 95 % CI 1.01–3.98, P = 0.046).

Conclusion

The presence of both CKD and anemia in patients undergoing CABG for coronary artery disease is synergistically associated with a worse outcome.

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References

  1. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014;9:e84943.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Minakata K, Bando K, Tanaka S, Takanashi S, Konishi H, Miyamoto Y, Ueshima K, Yasuno S, Ueda Y, Okita Y, Masuda I, Okabayashi H, Yaku H, Okamura Y, Tanemoto K, et al. Preoperative chronic kidney disease as a strong predictor of postoperative infection and mortality after coronary artery bypass grafting. Circ J. 2014;78:2225–31.

    Article  PubMed  Google Scholar 

  3. Winkelmayer WC, Levin R, Avorn J. Chronic kidney disease as a risk factor for bleeding complications after coronary artery bypass surgery. Am J Kidney Dis. 2003;41:84–9.

    Article  PubMed  Google Scholar 

  4. Holzmann M, Jernberg T, Szummer K, Sartipy U. Long-term cardiovascular outcomes in patients with chronic kidney disease undergoing coronary artery bypass graft surgery for acute coronary syndromes. J Am Heart Assoc. 2014;3:e000707.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cooper WA, O’Brien SM, Thourani VH, Guyton RA, Bridges CR, Szczech LA, Petersen R, Peterson ED. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation. 2006;113:1063–70.

    Article  PubMed  Google Scholar 

  6. Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, Moehnle P, Mangano DT, Investigators of the Multicenter Study of Perioperative Ischemia Research G, Ischemia R, Education F. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation. 2007;116:471–9.

    Article  PubMed  Google Scholar 

  7. Boening A, Boedeker RH, Scheibelhut C, Rietzschel J, Roth P, Schonburg M. Anemia before coronary artery bypass surgery as additional risk factor increases the perioperative risk. Ann Thorac Surg. 2011;92:805–10.

    Article  PubMed  Google Scholar 

  8. Bell ML, Grunwald GK, Baltz JH, McDonald GO, Bell MR, Grover FL, Shroyer AL. Does preoperative hemoglobin independently predict short-term outcomes after coronary artery bypass graft surgery? Ann Thorac Surg. 2008;86:1415–23.

    Article  PubMed  Google Scholar 

  9. Leeder SR, Mitchell P, Liew G, Rochtchina E, Smith W, Wang JJ. Low hemoglobin, chronic kidney disease, and risk for coronary heart disease-related death: the Blue Mountains Eye Study. J Am Soc Nephrol. 2006;17:279–84.

    Article  PubMed  Google Scholar 

  10. Anderson J, Glynn LG, Newell J, Iglesias AA, Reddan D, Murphy AW. The impact of renal insufficiency and anaemia on survival in patients with cardiovascular disease: a cohort study. BMC Cardiovasc Disord. 2009;9:51.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shiraishi J, Kohno Y, Nakamura T, Yanagiuchi T, Hashimoto S, Ito D, Kimura M, Matsui A, Yokoi H, Arihara M, Hyogo M, Shima T, Sawada T, Matoba S, Yamada H, et al. Prognostic impact of chronic kidney disease and anemia at admission on in-hospital outcomes after primary percutaneous coronary intervention for acute myocardial infarction. Int Heart J. 2014;55:301–6.

    Article  PubMed  Google Scholar 

  12. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.

    Article  CAS  PubMed  Google Scholar 

  13. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A. Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  PubMed  Google Scholar 

  14. National Kidney F. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39:S1-266.

  15. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975; 51:5–40.

  16. Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Lockowandt U. EuroSCORE II. Eur J Cardiothorac Surg. 2012; 41:734–44 (discussion 44–5).

  17. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.

    Article  CAS  Google Scholar 

  18. Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM. Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol. 2003;14:2919–25.

    Article  CAS  PubMed  Google Scholar 

  19. Basile JN. Clinical considerations and practical recommendations for the primary care practitioner in the management of anemia of chronic kidney disease. South Med J. 2007;100:1200–7.

    Article  PubMed  Google Scholar 

  20. Kazory A, Ross EA. Anemia: the point of convergence or divergence for kidney disease and heart failure? J Am Coll Cardiol. 2009;53:639–47.

    Article  PubMed  Google Scholar 

  21. Matsue Y, Matsumura A, Abe M, Ono M, Seya M, Nakamura T, Iwatsuka R, Mizukami A, Setoguchi M, Nagahori W, Ohno M, Suzuki M, Hashimoto Y. Prognostic implications of chronic kidney disease and anemia after percutaneous coronary intervention in acute myocardial infarction patients. Heart Vessels. 2013;28:19–26.

    Article  PubMed  Google Scholar 

  22. Wellenius GA, Mukamal KJ, Winkelmayer WC, Mittleman MA. Renal dysfunction increases the risk of saphenous vein graft occlusion: results from the Post-CABG trial. Atherosclerosis. 2007;193:414–20.

    Article  CAS  PubMed  Google Scholar 

  23. Zheng Z, Zhang L, Hu S, Li X, Yuan X, Gao H, Chinese Cardiovascular Surgical Registry S. Risk factors and in-hospital mortality in Chinese patients undergoing coronary artery bypass grafting: analysis of a large multi-institutional Chinese database. J Thorac Cardiovasc Surg. 2012; 144:355–9, 9 e1.

  24. Boning A, Diegeler A, Hilker M, Zacher M, Reents W, Faerber G, Doenst T, investigators G. Preoperative atrial fibrillation and outcome in patients undergoing on-pump or off-pump coronary bypass surgery: lessons learned from the GOPCABE trial. Interact Cardiovasc Thorac Surg. 2015; 20:74–8.

  25. Birkmeyer JD, O’Connor GT, Quinton HB, Ricci MA, Morton JR, Leavitt BJ, Charlesworth DC, Hernandez F, McDaniel MD. The effect of peripheral vascular disease on in-hospital mortality rates with coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. J Vasc Surg. 1995;21:445–52.

    Article  CAS  PubMed  Google Scholar 

  26. Chung PJ, Carter TI, Burack JH, Tam S, Alfonso A, Sugiyama G. Predicting the risk of death following coronary artery bypass graft made simple: a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database. J Cardiothorac Surg. 2015;10:62.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yacoub R, Patel N, Lohr JW, Rajagopalan S, Nader N, Arora P. Acute kidney injury and death associated with renin angiotensin system blockade in cardiothoracic surgery: a meta-analysis of observational studies. Am J Kidney Dis. 2013;62:1077–86.

    Article  PubMed  Google Scholar 

  28. Bandeali SJ, Kayani WT, Lee VV, Pan W, Elayda MA, Nambi V, Jneid HM, Alam M, Wilson JM, Birnbaum Y, Ballantyne CM, Virani SS. Outcomes of preoperative angiotensin-converting enzyme inhibitor therapy in patients undergoing isolated coronary artery bypass grafting. Am J Cardiol. 2012;110:919–23.

    Article  CAS  PubMed  Google Scholar 

  29. Akbari A, Clase CM, Acott P, Battistella M, Bello A, Feltmate P, Grill A, Karsanji M, Komenda P, Madore F, Manns BJ, Mahdavi S, Mustafa RA, Smyth A, Welcher ES. Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management. Am J Kidney Dis. 2015;65:177–205.

    Article  CAS  PubMed  Google Scholar 

  30. Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, Fukushima J, Kalil Filho R, Sierra DB, Lopes NH, Mauad T, Roquim AC, Sundin MR, Leao WC, Almeida JP, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010;304:1559–67.

    Article  CAS  PubMed  Google Scholar 

  31. Weltert L, D’Alessandro S, Nardella S, Girola F, Bellisario A, Maselli D, De Paulis R. Preoperative very short-term, high-dose erythropoietin administration diminishes blood transfusion rate in off-pump coronary artery bypass: a randomized blind controlled study. J Thorac Cardiovasc Surg. 2010; 139:621–6 (discussion 6–7).

  32. Tasanarong A, Duangchana S, Sumransurp S, Homvises B, Satdhabudha O. Prophylaxis with erythropoietin versus placebo reduces acute kidney injury and neutrophil gelatinase-associated lipocalin in patients undergoing cardiac surgery: a randomized, double-blind controlled trial. BMC Nephrol. 2013;14:136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Kameda Medical Center, Chiba, Japan

    Takuya Ogami, Ryo Kawasumi & Hiroaki Tanabe

  2. Department of Cardiology, Kameda Medical Center, 929, Higashi-Cho, Kamogawa, Chiba, Japan

    Yuya Matsue

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  1. Takuya Ogami
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  2. Yuya Matsue
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  3. Ryo Kawasumi
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  4. Hiroaki Tanabe
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Correspondence to Yuya Matsue.

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Conflict of interest

YM received honoraria from SUNRISE Lab. as a manuscript fee. The other authors have no conflicts of interest.

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Ogami, T., Matsue, Y., Kawasumi, R. et al. Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery. Surg Today 47, 245–251 (2017). https://doi.org/10.1007/s00595-016-1368-7

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  • DOI: https://doi.org/10.1007/s00595-016-1368-7

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