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Chang CY, Chien YJ, Kao MC, Lin HY, Chen YL, Wu MY. Pre-operative proteinuria, postoperative acute kidney injury and mortality: A systematic review and meta-analysis. Eur J Anaesthesiol 2021; 38:702-714. [PMID: 34101638 DOI: 10.1097/eja.0000000000001542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up. BACKGROUND Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting. METHODS We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a random-effects model, the pooled effect estimates and 95% confidence interval (CI) were calculated. RESULTS Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], in-hospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3+. CONCLUSION Pre-operative proteinuria is significantly associated with postoperative AKI and long-term mortality. Pre-operative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients. PROSPERO REGISTRATION CRD42020190065.
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Affiliation(s)
- Chun-Yu Chang
- From the Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (C-YC, M-CK, H-YL), Department of Anesthesiology, School of Medicine, Tzu Chi University, Hualien (C-YC, M-CK, H-YL), Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (Y-JC), Department of Physical Medicine and Rehabilitation, School of Medicine, Tzu Chi University, Hualien (Y-JC), Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (Y-LC, M-YW) and Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan (Y-LC, M-YW)
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Kusu‐Orkar T, Kermali M, Oguamanam N, Bithas C, Harky A. Coronary artery bypass grafting: Factors affecting outcomes. J Card Surg 2020; 35:3503-3511. [DOI: 10.1111/jocs.15013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Nina Oguamanam
- Department of Emergency Medicine East Sussex Healthcare NHS Trust Seaford UK
| | | | - Amer Harky
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Hospital Liverpool UK
- Liverpool Center for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool UK
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Kwon JT, Jung TE, Lee DH. Predictive risk factors of acute kidney injury after on-pump coronary artery bypass grafting. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:44. [PMID: 30906748 DOI: 10.21037/atm.2018.12.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) and increases the risk of short and long-term morbidity and mortality. The aim of our study is to identify preoperative and intraoperative risk factors for development of AKI after primary isolated on-pump CABG. Methods In the retrospective study, 210 consecutive patients who underwent primary isolated on-pump CABG from January 2007 to March 2016 were included. The patients were divided into without AKI group (Group 1) and AKI group (Group 2) after operation. The s-Cr levels were recorded pre and postoperatively. The demographics, preoperative and postoperative data were collected from patient's medical profile and analyzed statistically. Results AKI developed in 40.5% of the patients (85 patients out of 210 patients). Age (Group 1; Group 2, 63.7±8.6; 67.2±8.2, P=0.004), body surface area (BSA) (Group 1; Group 2, 1.71±0.16; 1.64±0.16, P=0.003), body weight (Group 1; Group 2, 64.1±10.0; 60.7±10.2, P=0.017) were statistically significant for the development of AKI. However, preoperative hemoglobin, blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR) and C-reactive protein (CRP) were not significant. As intraoperative factors, total pump time (TPT), aortic cross clamp time and transfusion were not significant. Female gender (OR 1.88; P=0.044), preoperative proteinuria (OR 2.711; P=0.011) and emergent operation (OR 2.641; P=0.035) were risk factors in univariate analysis. Preoperative proteinuria (OR 2.396; P=0.035) was only risk factor in multivariate analysis. Conclusions Preoperative proteinuria was an independent predictor of postoperative AKI in patients undergoing primary isolated on-pump CABG. The accurate risk prediction of AKI after surgery can help clinicians manage more effectively in high-risk patients.
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Affiliation(s)
- Jin-Tae Kwon
- Department of Chest Surgery, Bundang Jesaeng Hospital, Seongnam, Republic of Korea
| | - Tae-Eun Jung
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Dong-Hyup Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Lima EG, Hueb W, Gersh BJ, Rezende PC, Garzillo CL, Favarato D, Hueb AC, Rahmi Garcia RM, Franchini Ramires JA, Filho RK. Impact of Chronic Kidney Disease on Long-Term Outcomes in Type 2 Diabetic Patients With Coronary Artery Disease on Surgical, Angioplasty, or Medical Treatment. Ann Thorac Surg 2016; 101:1735-44. [DOI: 10.1016/j.athoracsur.2015.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
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Kuo YT, Chiu KM, Tsang YM, Chiu CM, Chien MY. Influence of Chronic Kidney Disease on Physical Function and Quality of Life in Patients after Coronary Artery Bypass Grafting. Cardiorenal Med 2015; 5:237-45. [PMID: 26648940 DOI: 10.1159/000433447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 05/08/2015] [Indexed: 01/26/2023] Open
Abstract
AIMS The purposes of this study were (1) to compare body composition, physical function, and quality of life (QOL) between patients after coronary artery bypass grafting (CABG) with and without chronic kidney disease (CKD) and (2) to analyze the factors associated with physical function and QOL domains in these patients. METHODS Thirty male post-CABG patients with CKD and 30 matched controls were recruited. All subjects underwent dual-energy X-ray absorptiometry for body composition evaluation. Physical function tests included the grip strength test, 30-second chair stand test (30CST), and 6-min walk test (6MWT). Physical activity and QOL were assessed using the long form of the International Physical Activity Questionnaire and the World Health Organization Quality of Life Instrument (WHOQOL)-BREF, respectively. RESULTS Post-CABG patients with CKD exhibited a lower arm lean mass and higher percent leg fat mass than those without CKD (p < 0.05). The patients with CKD also had lower 30CST scores, 6MWT distances, and QOL domain of social relationships scores than those without CKD after adjusting for covariates (p < 0.05). If NYHA class was considered in the model, NYHA class became the most important factor associated with 6MWT distances (β = -0.647, p < 0.001) and the QOL domains of psychological health (β = -0.285, p = 0.027) and environment (β = -0.406, p = 0.001). CONCLUSION Post-CABG patients with CKD had worse body composition, physical function, and QOL than those without CKD, and this might be associated with a worse NYHA class.
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Affiliation(s)
- Yueh-Ting Kuo
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, ROC ; Department of Rehabilitation, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Kuan-Ming Chiu
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Yuk-Ming Tsang
- Division of Medical Imaging, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Cheng-Ming Chiu
- Department of Rehabilitation, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Meng-Yueh Chien
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, ROC
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Wu VC, Huang TM, Wu PC, Wang WJ, Chao CT, Yang SY, Shiao CC, Hu FC, Lai CF, Lin YF, Han YY, Chen YS, Hsu RB, Young GH, Wang SS, Tsai PR, Chen YM, Chao TT, Ko WJ, Wu KD. Preoperative proteinuria is associated with long-term progression to chronic dialysis and mortality after coronary artery bypass grafting surgery. PLoS One 2012; 7:e27687. [PMID: 22276092 PMCID: PMC3262783 DOI: 10.1371/journal.pone.0027687] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 10/21/2011] [Indexed: 11/23/2022] Open
Abstract
AIMS Preoperative proteinuria is associated with post-operative acute kidney injury (AKI), but whether it is also associated with increased long-term mortality and end-stage renal disease (ESRD) is unknown. METHODS AND RESULTS We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+) or heavy (2+ to 4+) according to the results of the dipstick test. A total of 276 (29.8%) patients had mild proteinuria before surgery and 119 (12.9%) patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17) was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88) and heavy proteinuria ([HR], 2.28) to predict all-cause mortality compared to no proteinuria. Mild ([HR], 2.57) and heavy proteinuria ([HR], 2.70) exhibited a stepwise increased ratio compared to patients without proteinuria for long-term composite catastrophic outcomes (mortality and ESRD), which were independent of the baseline GFR and postoperative acute kidney injury (AKI). CONCLUSION Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients.
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Affiliation(s)
- Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tao-Min Huang
- Division of Nephrology, Department of Internal Medicine, Yun-Lin Branch, National Taiwan University Hospital, Douliou, Taiwan
| | - Pei-Chen Wu
- Division of Nephrology, Department of Internal Medicine, Da Chien General Hospital, Miaoli, Taiwan
| | - Wei-Jie Wang
- Department of Internal Medicine, Taoyuan General Hospital, Department of Health, Executive Yuan, Taoyuan, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shao-Yu Yang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital, and Saint Mary's Medicine, Nursing, and Management College, Luodong, Yilan
| | - Fu-Chang Hu
- International Harvard Statistical Consulting Company, Taipei, Taiwan
| | - Chun-Fu Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Feng Lin
- Department of Raumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Yi Han
- Department of Raumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ron-Bin Hsu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Guang-Huar Young
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shoei-Shen Wang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Pi-Ru Tsai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Ting Chao
- Medical Research Center, Cardinal Tien Hospital, Fu Jen Catholic University College of Medicine, Taipei, Taiwan
| | - Wen-Je Ko
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Raumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kwan-Dun Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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