Impacts of non-dialysis-dependent renal insufficiency on the early surgical outcomes after isolated coronary artery bypass graft surgery İzole koroner arter baypas greft cerrahisinden sonra diyalize bağimli olmayan renal yetersizliğin erken cerrahi sonuçlar üzerindeki etkileri

Amac: Bu calismada kreatinin klirensi ve serum kreatinin ile degerlendirilen diyalize bagimli olmayan renal yetersizligin ameliyat sonrasi mortalite ve komplikasyonlar uzerindeki etkileri arastirildi. Ca­lis­ma­pla­ni:­Agustos 2007 Mart 2011 tarihleri arasinda Iran, Tahran Shariati Hastanesi’nde izole koroner arter baypas greft (KABG) cerrahisi yapilan toplam 1359 ardisik hasta (975 kadin, 384 erkek; ort. yas 58.6±10.1 yil; dagilim 23-87 yil) retrospektif olarak incelendi. Hastalar ameliyat oncesi kreatinin klirensi degerlerine gore renal (R grubu; n=21) (<30 mL/dk.) ve kontrol grubu (K grubu; n=1338) (≥30 mL/dk.) olarak siniflandirildi. Iki grup ameliyat oncesi ozellikler acisindan karsilastirildi. Ameliyat oncesi renal yetersizligin KABG sonrasi mortalite ve morbidite oranlari uzerindeki etkisi, kademeli cok degiskenli lojistik regresyon analizleri kullanilarak incelendi. Bul gu lar: Koroner arter baypas greft cerrahisi sonrasi renal yetmezlik (%0.4’e kiyasla %9.5) ve mortalite orani (%3.3’e kiyasla %19.0) grup C’ye kiyasla, grup R’de daha fazlaydi (p<0.001). Renal bozukluk, koroner arter baypas greft cerrahisi sonrasi renal yetersizlik ve diyaliz (OR=1.05, %95 CI: 1.02-1.07; p=0.001) ile erken mortalitenin (OR=1.16, %95 CI: 1.07-1.25; p=0.001) bagimsiz bir ongordurucusuydu. So­nuc:­ Ameliyat oncesi diyalize bagimli olmayan renal yetersizlik, KABG cerrahisi sonrasi renal yetmezlik ve mortalite icin en onemli risk faktorudur. Ozellikle bobrek bozukluklari gibi risk faktorleri tasiyan hastalara ozel ihtimam gosterilmelidir. Anah tar soz cuk ler: Koroner arter baypas grefti; mortalite; diyalize bagimli olmayan renal yetersizlik. Background:­ This study aims to investigate the effects of non-dialysis-dependent renal dysfunction on postoperative mortality and complications assessed by creatinine clearance and serum creatinine. Methods: Between August 2007 and March 2011, a total of 1,359 consecutive patients (975 females, 384 males; mean age 58.6±10.1 years; range 23 to 87 years) who underwent isolated coronary artery bypass grafting (CABG) surgery in Shariati Hospital, Tehran, Iran were retrospectively analyzed. Patients were classified based on the preoperative creatinine clearance values to group renal (group R; n=21) (<30 mL/min) and group control (group C; n=1338) (≥30 mL/min). Two groups were compared for preoperative characteristics. Effects of preoperative renal insufficiency on post-CABG mortality and morbidity rates were measured using stepwise multivariate logistic regression analyses. Results:­Post-coronary artery bypass grafting surgery renal failure (9.5% vs. 0.4%) and mortality rates (19.0% vs. 3.3%) were higher in group R compared to group C (p<0.001). Renal impairment was an independent predictor for postCABG surgery renal insufficiency and dialysis (OR=1.05, 95% CI: 1.02-1.07; p=0.001) and early mortality (OR=1.16, 95% CI: 1.07-1.25; p=0.001). Conclusion:­ Preoperative non-dialysis-dependent renal insufficiency is the most important risk factor for post-CABG surgery renal failure and mortality. A specific attention is warranted to patients with pre-existing risk factors especially renal impairments.