Abstract: FR-PO125

Synergistic Effects of AKI and CKD on the Development of ESRD after Coronary Artery Bypass Grafting

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Lee, Yeonhee, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital, Seongnam, GYEONGGI-DO, Korea (the Republic of)
  • Han, Seung Seok, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Moon, Hongran, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, GYEONGGI-DO, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Oh, Yun Kyu, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, GYEONGGI-DO, Korea (the Republic of)
  • Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital, Seoul, Korea (the Republic of)
Background

Because end-stage renal disease (ESRD) affects patient outcomes in several diseases, exploring risk factors for ESRD is a critical issue in clinical practice. This study firstly addressed to evaluate the synergistic effects of acute kidney injury (AKI) and chronic kidney disease (CKD) on the development of ESRD in patients with coronary artery bypass grafting (CABG).

Methods

This study included 1,899 patients (aged ≥18 years) underwent CABG between 2004 and 2015 in two tertiary referral centers. Patients were classified as groups with postoperative AKI, preoperative CKD, or both according to the KDIGO guidelines. We performed the Kaplan-Meier method and the multivariable Cox regression model to calculate the cumulative incidence of ESRD and to estimate the hazard ratio of ESRD. Patients were followed for 74±44 months (maximum 13 years).

Results

Postoperative AKI occurred in 799 patients (26.5%), including 23.8% in stage 1 and 2.7% in stages 2 and 3. CKD was identified in 890 patients (29.5%). ESRD occurred in 60 patients (1.4%) as following subject numbers and proportions: the group without AKI and CKD, 6 (0.4%); the AKI group, 6 (1.2%); the CKD group, 20 (3.4%); and the group with both AKI and CKD, 28 (9.2%). The cumulative rate of ESRD increased in the following order, the group without AKI and CKD, the AKI group, the CKD group, and the group with both AKI and CKD (Figure). In multivariate analyses, both AKI [HR, 3.2 (1.01-10.13)] and CKD [HR, 9.2 (3.46-24.43)] were independently associated with the risk of ESRD (all Ps<0.05). Particularly, in the CKD patients, the presence of AKI significantly increased the risk of ESRD compared with the counterpart group without AKI, as follows: HR, 3.4 (1.91-6.04); P<0.05.

Conclusion

The presences of AKI and CKD synergistically increase the risk of ESRD in CABG patients.