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Kidney Week

Abstract: TH-PO075

Risks and Outcomes of Postoperative Dialysis-Requiring AKI in Patients Who Underwent Coronary Artery Bypass Grafting Surgery: A Large Retrospective Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Chiu, Ijen, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
  • Hsiao, Li-Li, Brigham and Women's Hospital , Harvard Medical University, Boston, Massachusetts, United States
  • Hsu, Yung-Ho, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Background

In-hospital acute kidney injury (AKI) has been linked to higher mortality and kidney disease progression. We aim to evaluate the associated factors and long-term outcome from patients underwent coronary artery bypass grafting (CABG) surgery, who developed dialysis-requiring AKI.

Methods

Data were collected by the National Health Insurance Research Database of Taiwan from 2002 to 2012. Individuals 18 and older, who underwent scheduled isolated CABG were identified (n=33790). Patients who were ESRD or received renal replacement therapy (RRT) within one year before surgery were excluded. AKI requiring dialysis was identified by the dialysis procedure code. The long-term mortality and ESRD were examined using multivariate Cox regression.

Results

The incidence of dialysis-requiring AKI after CABG is 7.6% (2,575). Patients with age 65 and older, history of Type 2 diabetes (T2DM), hypertension (HTN) and use of Angiotensin receptor blocker (ARB), erythropoietin (EPO) as well as on-pump CABG were the risk factors. And older age (>=65 y.o), T2DM and in-hospital RRT were associated with increased long-term mortality (HR 2.62, 1.49 & 4.47, p<0.0001). RRT also had a significantly increased risk of progression to ESRD (HR 17.16, p<0.0001). Neither on-pump nor off-pump CABG affects long-term mortality (HR 0.95, p=0.051), but on-pump CABG patients had a higher risk of developing ESRD (HR 1.19, p=0.001). While preoperative statin use linked to lower long-term mortality (HR 0.82), it caused a higher risk of ESRD progression (HR 1.23m)(p<0.0001). A similar observation was also seen in ARB use (HR 1.23, p< 0.0001). Furthermore, EPO use significantly increased the risk of progression to ESRD (HR 7.10, p<0.0001) despite no worsening effect on long-term mortality (HR 0.77, p=0.13)

Conclusion

We have identified the risk factors that increase the incidence of dialysis-requiring AKI after CABG; we further identified factors that affect the risk of mortality and ESRD progression. Statin appears to have protective effects in mortality and on-pump CABG showed higher risks in developing post-operative AKI and ESRD progression. Our finding may serve as a guideline for risk assessment and managing those who undergo CABG.