Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Rui , ZHU Yifan , CHEN Wen , JING Qiming ,  CHEN Xin

Department of Cardiovascular Surgery, Nanjing Cardiovascular Hospital, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R.China;

Corresponding author：

CHEN Xin, Email: stevecx1@163.com

Keywords：

Coronary artery bypass grafting; elderly; acute kidney injury; cardiopulmonary bypass; off-pump

DOI：

10.7507/1007-4848.201808037

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Objective To compare the impact of cardiopulmonary coronary artery bypass grafting (CCABG) and off-pump coronary artery bypass grafting (OPCAB) on the incidence of postoperative acute kidney injury (AKI) in the elderly patients (age≥70 years). Methods The clinical data of the isolated coronary artery bypass grafting (CABG) patients (age≥70 years) in our center from January 1, 2009 to December 31, 2017 were collected and retrospectively analyzed. The patients with long-term dialysis, missing serum creatinine data, emergent surgery or CABG combined with other cardiac procedures were excluded. Totally there were 3 346 patients undergoing isolated CABG, and finally 1 405 patients (age≥70 years) entered the study. The elderly patients were divided into a CCABG group (956 patients) and an OPCAB group (449 patients) according to whether they used extracorporeal circulation. The incidence and severity of postoperative AKI in the two groups were compared. Results AKI occurred in 306 (32.0%) patients in the CCABG group and in 138 (30.7%) patients in the OPCAB group with no significant difference (P=0.677). According to the acute kidney injury network (AKIN) criteria, the severity of AKI in the CCABG vs. OPCAB was as followings, AKIN stage Ⅰ: 211 (22.1%) vs. 93 (20.7%); AKIN stage Ⅱ: 51 (5.3%) vs. 23 (5.1%); and AKIN stage Ⅲ: 44 (4.6%) vs. 22 (4.9%) with no significant difference (P=0.579, 1.000 and 0.788). There was no significant difference in the new onset of dialysis between the CCABG group (31 patients, 3.2%) and the OPCAB group (10 patients, 2.2%, P=0.376). Conclusion AKI is a common complication in the elderly CABG patients, with AKIN stage Ⅰ accounting for the most proportion, but rate of postoperative renal replacement therapy is low. Compared with CCABG, OPCAB is not associated with a significantly low rate or reduced severity of AKI in elderly patients.

Citation： WANG Rui, ZHU Yifan, CHEN Wen, JING Qiming, CHEN Xin. Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(6): 548-552. doi: 10.7507/1007-4848.201808037 Copy

1.	Kellum JA, Bellomo R, Ronco C. Progress in prevention and treatment of acute kidney injury: Moving beyond kidney attack. JAMA, 2018, 320(5): 437-438.
2.	Burton JO, Goldsmith DJ, Ruddock N, et al. Renal association commentary on the KDIGO (2017) clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of CKD-MBD. BMC Nephrol, 2018, 19(1): 240.
3.	Reents W, Hilker M, Börgermann J, et al. Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients. Ann Thorac Surg, 2014, 98(1): 9-14.
4.	Chen JJ, Lin LY, Yang YH, et al. On pump versus off pump coronary artery bypass grafting in patients with end-stage renal disease and coronary artery disease - A nation-wide, propensity score matched database analyses. Int J Cardiol, 2017, 227: 529-534.
5.	Deininger S, Hoenicka M, Müller-Eising K, et al. Renal function and urinary biomarkers in cardiac bypass surgery: a prospective randomized trial comparing three surgical techniques. Thorac Cardiovasc Surg, 2016, 64(7): 561-568.
6.	Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care, 2007, 11(2): R31.
7.	García Fuster R, Paredes F, García Peláez A, et al. Impact of increasing degrees of renal impairment on outcomes of coronary artery bypass grafting: the off-pump advantage. Eur J Cardiothorac Surg, 2013, 44(4): 732-742.
8.	Holzmann MJ, Sartipy U. Relation between preoperative renal dysfunction and cardiovascular events (stroke, myocardial infarction, or heart failure or death) within three months of isolated coronary artery bypass grafting. Am J Cardiol, 2013, 112(9): 1342-1346.
9.	孙忠东, 池一凡, 矫艳, 等. 75 岁以上冠心病患者行冠状动脉旁路移植术疗效分析. 中国胸心血管外科临床杂志, 2016, 23(4): 405-407.
10.	KDIGO. Section 5: Dialysis interventions for treatment of AKI. Kidney Int Suppl (2011), 2012, 2(1): 89-115.
11.	Gallagher S, Kapur A, Lovell MJ, et al. Impact of diabetes mellitus and renal insufficiency on 5-year mortality following coronary artery bypass graft surgery: a cohort study of 4869 UK patients. Eur J Cardiothorac Surg, 2014, 45(6): 1075-1081.
12.	Ortega-Loubon C, Fernández-Molina M, Pañeda-Delgado L, et al. Predictors of postoperative acute kidney injury after coronary artery bypass graft surgery. Braz J Cardiovasc Surg, 2018, 33(4): 323-329.
13.	Mithiran H, Kunnath Bonney G, Bose S, et al. A score for predicting acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Cardiothorac Vasc Anesth, 2016, 30(5): 1296-1301.
14.	Chalmers J, Mediratta N, McShane J, et al. The long-term effects of developing renal failure post-coronary artery bypass surgery, in patients with normal preoperative renal function. Eur J Cardiothorac Surg, 2013, 43(3): 555-559.
15.	Seabra VF, Alobaidi S, Balk EM, et al. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol, 2010, 5(10): 1734-1744.
16.	Holzmann MJ, Gardell C, Jeppsson A, et al. Renal dysfunction and long-term risk of heart failure after coronary artery bypass grafting. Am Heart J, 2013, 166(1): 142-149.
17.	Lim JY, Deo SV, Jung SH, et al. Does off-pump coronary artery bypass confer any advantage in patients with end-stage renal failure? A systematic review and meta-analysis. Heart Lung Circ, 2015, 24(1): 55-61.
18.	Nigwekar SU, Kandula P, Hix JK, et al. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized and observational studies. Am J Kidney Dis, 2009, 54(3): 413-423.
19.	Schopka S, Diez C, Camboni D, et al. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis. J Cardiothorac Surg, 2014, 9: 20.
20.	Garg AX, Devereaux PJ, Yusuf S, et al. Kidney function after off-pump or on-pump coronary artery bypass graft surgery: a randomized clinical trial. JAMA, 2014, 311(21): 2191-2198.
21.	Chikwe J, Lee T, Itagaki S, et al. Long-term outcomes after off-pump versus on-pump coronary artery bypass grafting by experienced surgeons. J Am Coll Cardiol, 2018, 72(13): 1478-1486.
22.	Rydén L, Sartipy U, Evans M, et al. Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease. Circulation, 2014, 130(23): 2005-2011.

1. Kellum JA, Bellomo R, Ronco C. Progress in prevention and treatment of acute kidney injury: Moving beyond kidney attack. JAMA, 2018, 320(5): 437-438.
2. Burton JO, Goldsmith DJ, Ruddock N, et al. Renal association commentary on the KDIGO (2017) clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of CKD-MBD. BMC Nephrol, 2018, 19(1): 240.
3. Reents W, Hilker M, Börgermann J, et al. Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients. Ann Thorac Surg, 2014, 98(1): 9-14.
4. Chen JJ, Lin LY, Yang YH, et al. On pump versus off pump coronary artery bypass grafting in patients with end-stage renal disease and coronary artery disease - A nation-wide, propensity score matched database analyses. Int J Cardiol, 2017, 227: 529-534.
5. Deininger S, Hoenicka M, Müller-Eising K, et al. Renal function and urinary biomarkers in cardiac bypass surgery: a prospective randomized trial comparing three surgical techniques. Thorac Cardiovasc Surg, 2016, 64(7): 561-568.
6. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care, 2007, 11(2): R31.
7. García Fuster R, Paredes F, García Peláez A, et al. Impact of increasing degrees of renal impairment on outcomes of coronary artery bypass grafting: the off-pump advantage. Eur J Cardiothorac Surg, 2013, 44(4): 732-742.
8. Holzmann MJ, Sartipy U. Relation between preoperative renal dysfunction and cardiovascular events (stroke, myocardial infarction, or heart failure or death) within three months of isolated coronary artery bypass grafting. Am J Cardiol, 2013, 112(9): 1342-1346.
9. 孙忠东, 池一凡, 矫艳, 等. 75 岁以上冠心病患者行冠状动脉旁路移植术疗效分析. 中国胸心血管外科临床杂志, 2016, 23(4): 405-407.
10. KDIGO. Section 5: Dialysis interventions for treatment of AKI. Kidney Int Suppl (2011), 2012, 2(1): 89-115.
11. Gallagher S, Kapur A, Lovell MJ, et al. Impact of diabetes mellitus and renal insufficiency on 5-year mortality following coronary artery bypass graft surgery: a cohort study of 4869 UK patients. Eur J Cardiothorac Surg, 2014, 45(6): 1075-1081.
12. Ortega-Loubon C, Fernández-Molina M, Pañeda-Delgado L, et al. Predictors of postoperative acute kidney injury after coronary artery bypass graft surgery. Braz J Cardiovasc Surg, 2018, 33(4): 323-329.
13. Mithiran H, Kunnath Bonney G, Bose S, et al. A score for predicting acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Cardiothorac Vasc Anesth, 2016, 30(5): 1296-1301.
14. Chalmers J, Mediratta N, McShane J, et al. The long-term effects of developing renal failure post-coronary artery bypass surgery, in patients with normal preoperative renal function. Eur J Cardiothorac Surg, 2013, 43(3): 555-559.
15. Seabra VF, Alobaidi S, Balk EM, et al. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol, 2010, 5(10): 1734-1744.
16. Holzmann MJ, Gardell C, Jeppsson A, et al. Renal dysfunction and long-term risk of heart failure after coronary artery bypass grafting. Am Heart J, 2013, 166(1): 142-149.
17. Lim JY, Deo SV, Jung SH, et al. Does off-pump coronary artery bypass confer any advantage in patients with end-stage renal failure? A systematic review and meta-analysis. Heart Lung Circ, 2015, 24(1): 55-61.
18. Nigwekar SU, Kandula P, Hix JK, et al. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized and observational studies. Am J Kidney Dis, 2009, 54(3): 413-423.
19. Schopka S, Diez C, Camboni D, et al. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis. J Cardiothorac Surg, 2014, 9: 20.
20. Garg AX, Devereaux PJ, Yusuf S, et al. Kidney function after off-pump or on-pump coronary artery bypass graft surgery: a randomized clinical trial. JAMA, 2014, 311(21): 2191-2198.
21. Chikwe J, Lee T, Itagaki S, et al. Long-term outcomes after off-pump versus on-pump coronary artery bypass grafting by experienced surgeons. J Am Coll Cardiol, 2018, 72(13): 1478-1486.
22. Rydén L, Sartipy U, Evans M, et al. Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease. Circulation, 2014, 130(23): 2005-2011.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients

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