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Kidney Week

Abstract: PO2103

Outcomes of Cardiac Surgery in CKD Stage 3 vs. Stage 4 and 5

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Liaqat, Aimen, Cleveland Clinic, Cleveland, Ohio, United States
  • Bassil, Elias, Cleveland Clinic, Cleveland, Ohio, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Mehdi, Ali, Cleveland Clinic, Cleveland, Ohio, United States
  • Daou, Remy, Universite Saint-Joseph, Beirut, Lebanon
  • Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States
  • Konig, Victoria, Cleveland Clinic, Cleveland, Ohio, United States
  • Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States
  • Harb, Serge C., Cleveland Clinic, Cleveland, Ohio, United States
  • Wierup, Per, Cleveland Clinic, Cleveland, Ohio, United States
  • Demirjian, Sevag, Cleveland Clinic, Cleveland, Ohio, United States
  • Nakhoul, Georges, Cleveland Clinic, Cleveland, Ohio, United States
Background

Pre-operative kidney dysfunction is associated with worse outcomes following cardiac surgery. However, few studies have assessed the outcomes of advanced Stage 4 and 5 Chronic Kidney Disease (CKD) patients.

Methods

Using our Electronic CKD registry, we compared the outcomes of 988 patients with CKD stages 3 vs. 4 and 5 undergoing Coronary Artery Bypass Graft (CABG) and/or valvular cardiac surgery. We compared length of stay (LOS), ICU days, days on pressors, and days intubated as continuous values and as proportion above the 50th percentile using Kruskal-Wallis and Chi-square tests. We estimated Fine and Gray’s competing risks cumulative incidence function of days to post-operative AKI requiring dialysis (AKI-D) with mortality as a competing risk during hospitalization. We also compared the proportion developing AKI-D with Chi-square test.

Results

Among 988 total patients with cardiac surgery, 115 (12%) had CKD stage 4/5 and 873 (88%) had CKD stage 3. Average age was 71.2 ± 9.5 and 590 (59.7%) were male. Patients with CKD 4/5 had a higher proportion of diabetes (60% vs. 37%). Compared to CKD 3 patients, CKD 4/5 patients required longer intubation (33% more than 2 days compared to 20%, P=0.003), more pressors (47% more than 3 days vs. 32%, P=0.003), longer ICU LOS (median of 5 days vs. 4 days, P<0.001), longer post-operative LOS (median 12 days vs. 9, P<0.001). 24 patients (20.9%) with CKD 4/5 developed post-operative AKI-D vs. 42 (4.8%) in the CKD 3 group (p < 0.001). The cumulative incidence of End-Stage-Kidney Disease (ESKD) with death as a competing risk at 15 days was 5% (95% CI: 4, 8) in CKD 3 group vs. 24% (15, 33) in CKD 4/5 group (p < 0.001).(Table 1)

Conclusion

Advanced CKD stages 4/5 is associated with worse outcomes following cardiac surgery including prolonged ICU stay, intubation duration, days on pressors, development of AKI-D and ESKD.

Post-operative Outcomes in CKD Stage 3 Vs. Stage 4 and 5
FactorN missingStage 3
(N=873)
Stage 4 or 5
(N=115)
p-value
N ICU days114.0[3.0,7.0]5.0[3.0,11.0]<0.001b
Pressor days >3 (P50)201218(32.0)49(46.7)0.003c
Intubation days >2 (P50)58166(20.2)36(32.7)0.003c
Post AKID during admission042(4.8)24(20.9)<0.001c
In-Hospital Death032(3.7)5(4.3)0.72c
Post-op LOS09.0[7.0,13.0]12.0[8.0,19.0]<0.001b

Presented as Median [P25, P75] or N (column %). p-values: b=Kruskal-Wallis test, c=Pearson's chi-square test