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Impact of occult renal disease on the outcomes of off-pump and on-pump coronary artery bypass grafting

  • Lokeswara Rao Sajja
  • Sudhanshu Singh
  • Gopichand Mannam
  • Jyothsna Guttikonda
  • Venkata Ramachandra Raju Pusapati
  • Krishnamurthy Venkata Satya Siva Saikiran
Original Article
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Abstract

Purpose

Occult renal disease (ORD) is a clinical condition in which glomerular filtration rate (GFR) is less than 60 ml/min/1.73 m2, while serum creatinine is ≤ 1.3 mg/dl. The aim of the study was to compare the incidence of postoperative stage I acute kidney injury (AKI) according to Acute Kidney Injury Network (AKIN) classification in patients with ORD undergoing either off-pump or on-pump coronary artery bypass grafting.

Methods

A single center prospective randomized study was conducted from March 2011 through January 2014. A total of 120 coronary artery disease (CAD) patients with ORD undergoing coronary artery bypass grafting (CABG) were randomized to either off-pump (group1, n = 62) or on-pump (group2, n = 58) CABG in 1:1 ratio by computer-generated random number table. The GFR and serum creatinine levels were measured preoperatively and postoperatively on day 1 and day 5. The primary outcome (postoperative AKI (stage I)) and secondary outcomes (AKI (stage III) requiring renal replacement therapy (RRT) death, myocardial infarction (MI), cerebrovascular accident, atrial fibrillation (AF), and re-exploration for bleeding) at 30 days were analyzed between the groups.

Results

There is no significant difference in baseline characteristics of patients between off-pump and on-pump group. The incidence of postoperative AKI (stage I) was similar between on-pump (20.69%) and off-pump (16.13%) groups (p = 0.51). There was no significant difference in mortality (p = 0.33), postoperative MI (p = 0.34), cerebrovascular accident (p = 1.00), re-exploration (p = 0.96), and AF (p = 0.50). The number of patients of stage III AKI requiring RRT was higher in the off-pump group (3 patients, 4.8%) and none in the on-pump group (p = 0.08),

Conclusions

This study demonstrated that on-pump CABG is associated with significantly lower GFR and significantly higher serum creatinine on postoperative day 1 which return to baseline by postoperative day 5. In patients with ORD undergoing CABG, the incidence of postoperative AKI and major adverse cardiac and cerebrovascular events were similar between off-pump or on-pump CABG patients.

Keywords

ORD: Occult renal disease GFR: Glomerular filtration rate AKI: Acute kidney injury 

Notes

Acknowledgments

We thank Mr.A.Nadamuni Naidu, M.Sc (Stat), Head, Department of Statistics (Retired), National Institute of Nutrition, ICMR, Hyderabad, India, and Sajja Heart Foundation, Hyderabad, India, for statistical advice; and Prashanthi Beri M.Sc (Clinical Research), Clinical Research Associate, Sajja Heart Foundation, Hyderabad, India, for the help in preparing the manuscript and analysis for this study.

Compliance with ethical standards

This study complies with the principles of the Declaration of Helsinki and was approved by the institutional ethics committee, and informed consent was obtained from all the patients.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    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;113:1063–70.CrossRefPubMedGoogle Scholar
  2. 2.
    Chikwe J, Castillo JG, Rahmanian PB, Akujuo A, Adams DH, Filsoufi F. The impact of moderate-to-end-stage renal failure on outcomes after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2010;24:574–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Charytan DM, Yang SS, McGurk S, Rawn J. Long and short-term outcomes following coronary artery bypass grafting in patients with and without chronic kidney disease. Nephrol Dial Transplant. 2010;25:3654–63.CrossRefPubMedGoogle Scholar
  4. 4.
    Zakeri R, Freemantle N, Barnett V, et al. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation. 2005;112:I270–5.Google Scholar
  5. 5.
    Kellen M, Aronson S, Roizen MF, Barnard J, Thisted RA. Predictive and diagnostic tests of renal failure: a review. Anesth Analg. 1994;78:134–42.CrossRefPubMedGoogle Scholar
  6. 6.
    Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function—measured and estimated glomerular filtration rate. New Engl J Med. 2006;354:2473–83.CrossRefPubMedGoogle Scholar
  7. 7.
    Duncan L, Heathcote J, Djurdjev O, Levin A. Screening for renal disease using serum creatinine: who are we missing? Nephrol Dial Transplant. 2001;16:1042–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Rashid ST, Salman M, Agarwal S, Hamilton G. Occult renal impairment is common in patients with peripheral vascular disease and normal serum creatinine. Eur J Vasc Endovasc. 2006;32:294–9.CrossRefGoogle Scholar
  9. 9.
    Sajja LR, Mannam G, Chakravarthi RM, et al. Coronary artery bypass grafting with or without cardio pulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency: a randomized study. J Thorac Cardiovasc Surg. 2007;133:378–88.CrossRefGoogle Scholar
  10. 10.
    Miceli A, Bruno VD, Capoun R, Romeo F, Angelini GD, Caputo M. Occult renal dysfunction: a mortality and morbidity risk factor in coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg. 2011;141:771–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chertow GM, Lazarus JM, Christiansen CL, et al. Preoperative renal risk stratification. Circulation. 1997;95:878–84.CrossRefPubMedGoogle Scholar
  13. 13.
    Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15:1597–605.CrossRefPubMedGoogle Scholar
  14. 14.
    Provenchere S, Plantefeve G, Hufnagel G, et al. Renal dysfunction after cardiac surgery with normothermic cardiopulmonary bypass: incidence, risk factors, and effect on clinical outcome. Anesth Analg. 2003;96:1258–64.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim MY, Jang HR, Huh W, et al. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Ren Fail. 2011;33:316–22.CrossRefPubMedGoogle Scholar
  16. 16.
    Marui A, Okabayashi H, Komiya T, et al. Impact of occult renal impairment on early and late outcomes following coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2013;17:638–43.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Najafi M, Goodarznejad H, Karimi A, et al. Is preoperative serum creatinine a reliable indicator of outcome in patients undergoing coronary artery bypass surgery? J Thorac Cardiovasc Surg. 2009;137:304–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Sajja LR, Mannam G, Chakravarthi RM, Guttikonda J, Sompalli S, Bloomstone J. Impact of preoperative renal dysfunction on outcomes of off-pump coronary artery bypass grafting. Ann Thorac Surg. 2011;92:2161–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Pramodh K, Vani MK. Renal function following CABG: on-pump vs off-pump. Indian J Thorac Cardiovasc Surg. 2003;19:169–73.CrossRefGoogle Scholar
  20. 20.
    Sajja LR, Mannam GC, Chakravarthi RM. In search of strategies for optimizing outcomes in patients with compromised renal function undergoing coronary artery bypass grafting. Cardiology. 2008;111:21–2.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Lokeswara Rao Sajja
    • 1
    • 2
  • Sudhanshu Singh
    • 1
  • Gopichand Mannam
    • 1
  • Jyothsna Guttikonda
    • 2
    • 3
  • Venkata Ramachandra Raju Pusapati
    • 2
    • 4
  • Krishnamurthy Venkata Satya Siva Saikiran
    • 1
  1. 1.Division of Cardiothoracic SurgeryStar HospitalsHyderabadIndia
  2. 2.Sajja Heart FoundationHyderabadIndia
  3. 3.Division of NephrologyStar HospitalsHyderabadIndia
  4. 4.Division of CardiologyStar HospitalsHyderabadIndia

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