Renal Failure After Cardiac Operations: Not All Acute Kidney Injury Is the Same

Todd C. Crawford, J. Trent Magruder, Joshua C. Grimm, Shin Rong Lee, Alejandro Suarez-Pierre, David Lehenbauer, Christopher M. Sciortino, Robert Higgins, Duke E. Cameron, John V. Conte, Glenn Whitman

Research output: Contribution to journalArticle

Abstract

Background: The Society of Thoracic Surgeons (STS) database does not distinguish between a decline in creatinine clearance vs new hemodialysis (HD) when qualifying acute renal failure (ARF) after a cardiac operation. We hypothesized that patients requiring HD experience significantly greater postoperative morbidity and death. Methods: We included all patients who underwent STS index cardiac operations at our institution from 2008 to March 2015 and did not have preexisting renal failure (creatinine >4.0 mg/dL or preoperative HD). We identified patients meeting STS criteria for ARF: threefold rise in serum creatinine, creatinine exceeding 4.0 mg/dL (non-HD ARF) with minimum rise of 0.5 mg/dL, or HD (ARF-HD). After propensity matching non-HD ARF and ARF-HD groups across 14 variables (including baseline glomerular filtration rate), we compared incidences of our primary outcome, death, and secondary outcomes, intensive care unit (ICU) and hospital length of stay (LOS), and discharge to a location other than home. Results: Among 4,154 study patients, we identified 113 (2.7%) that experienced new-onset non-HD ARF (n = 57) or ARF-HD (n = 56) postoperatively. Propensity matching resulted in 51 well-matched pairs who experienced non-HD ARF or ARF-HD (all p > 0.10). Patients requiring HD suffered significantly greater operative mortality (67% vs 22%, p < 0.01), longer ICU LOS (326 vs 176 hours, p < 0.01), and greater postoperative hospital LOS (34 vs 17 days, p < 0.01). ARF-HD patients also demonstrated a trend toward higher rates of discharge to a location other than home (71% vs 45%, p = 0.08). Conclusions: After cardiac operations, patients who experienced ARF-HD experienced triple the mortality and double the ICU and postoperative hospital LOS compared with patients who experienced non-HD ARF.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2017

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Acute Kidney Injury
Renal Insufficiency
Renal Dialysis
Length of Stay
Creatinine
Intensive Care Units
Thorax
Mortality
Glomerular Filtration Rate
Databases
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Crawford, T. C., Magruder, J. T., Grimm, J. C., Lee, S. R., Suarez-Pierre, A., Lehenbauer, D., ... Whitman, G. (Accepted/In press). Renal Failure After Cardiac Operations: Not All Acute Kidney Injury Is the Same. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.01.019

Renal Failure After Cardiac Operations : Not All Acute Kidney Injury Is the Same. / Crawford, Todd C.; Magruder, J. Trent; Grimm, Joshua C.; Lee, Shin Rong; Suarez-Pierre, Alejandro; Lehenbauer, David; Sciortino, Christopher M.; Higgins, Robert; Cameron, Duke E.; Conte, John V.; Whitman, Glenn.

In: Annals of Thoracic Surgery, 2017.

Research output: Contribution to journalArticle

Crawford, TC, Magruder, JT, Grimm, JC, Lee, SR, Suarez-Pierre, A, Lehenbauer, D, Sciortino, CM, Higgins, R, Cameron, DE, Conte, JV & Whitman, G 2017, 'Renal Failure After Cardiac Operations: Not All Acute Kidney Injury Is the Same', Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.01.019
Crawford, Todd C. ; Magruder, J. Trent ; Grimm, Joshua C. ; Lee, Shin Rong ; Suarez-Pierre, Alejandro ; Lehenbauer, David ; Sciortino, Christopher M. ; Higgins, Robert ; Cameron, Duke E. ; Conte, John V. ; Whitman, Glenn. / Renal Failure After Cardiac Operations : Not All Acute Kidney Injury Is the Same. In: Annals of Thoracic Surgery. 2017.
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abstract = "Background: The Society of Thoracic Surgeons (STS) database does not distinguish between a decline in creatinine clearance vs new hemodialysis (HD) when qualifying acute renal failure (ARF) after a cardiac operation. We hypothesized that patients requiring HD experience significantly greater postoperative morbidity and death. Methods: We included all patients who underwent STS index cardiac operations at our institution from 2008 to March 2015 and did not have preexisting renal failure (creatinine >4.0 mg/dL or preoperative HD). We identified patients meeting STS criteria for ARF: threefold rise in serum creatinine, creatinine exceeding 4.0 mg/dL (non-HD ARF) with minimum rise of 0.5 mg/dL, or HD (ARF-HD). After propensity matching non-HD ARF and ARF-HD groups across 14 variables (including baseline glomerular filtration rate), we compared incidences of our primary outcome, death, and secondary outcomes, intensive care unit (ICU) and hospital length of stay (LOS), and discharge to a location other than home. Results: Among 4,154 study patients, we identified 113 (2.7{\%}) that experienced new-onset non-HD ARF (n = 57) or ARF-HD (n = 56) postoperatively. Propensity matching resulted in 51 well-matched pairs who experienced non-HD ARF or ARF-HD (all p > 0.10). Patients requiring HD suffered significantly greater operative mortality (67{\%} vs 22{\%}, p < 0.01), longer ICU LOS (326 vs 176 hours, p < 0.01), and greater postoperative hospital LOS (34 vs 17 days, p < 0.01). ARF-HD patients also demonstrated a trend toward higher rates of discharge to a location other than home (71{\%} vs 45{\%}, p = 0.08). Conclusions: After cardiac operations, patients who experienced ARF-HD experienced triple the mortality and double the ICU and postoperative hospital LOS compared with patients who experienced non-HD ARF.",
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T2 - Not All Acute Kidney Injury Is the Same

AU - Crawford, Todd C.

AU - Magruder, J. Trent

AU - Grimm, Joshua C.

AU - Lee, Shin Rong

AU - Suarez-Pierre, Alejandro

AU - Lehenbauer, David

AU - Sciortino, Christopher M.

AU - Higgins, Robert

AU - Cameron, Duke E.

AU - Conte, John V.

AU - Whitman, Glenn

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