Áhrif skertrar nýrnastarfsemi á snemmkominn árangur kransæðahjáveituaðgerða

Nanna Sveinsdottir; Sunna Run Heidarsdottir; Arni Steinn Steinthorsson; Hera Jóhannesdóttir; Alexandra Aldís Heimisdóttir; Tómas Þór Kristjánsson; Þórir Einarsson Long; Ingibjörg Jóna Guðmundsdóttir; Martin Ingi Sigurðsson; Tómas Guðbjartsson

doi:10.17992/LBL.2022.05.690

Áhrif skertrar nýrnastarfsemi á snemmkominn árangur kransæðahjáveituaðgerða

Translated title of the contribution: Impact of renal dysfunction on early outcomes of coronary artery bypass grafting surgery

Nanna Sveinsdottir, Sunna Run Heidarsdottir, Arni Steinn Steinthorsson, Hera Jóhannesdóttir, Alexandra Aldís Heimisdóttir, Tómas Þór Kristjánsson, Þórir Einarsson Long, Ingibjörg Jóna Guðmundsdóttir, Martin Ingi Sigurðsson, Tómas Guðbjartsson

Landspitali, University of Iceland

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: Impaired renal function as seen in chronic kidney disease (CKD) is a known risk factor for coronary artery diseases and has been linked to inferior outcome after myocardial revascularization. Studies on the outcome of coronary bypass grafting (CABG) in CKD-patients are scarce. We aimed to study this subgroup of patients following CABG in a well defined whole-nation cohort, focusing on short term complications and 30 day mortality.

MATERIALS AND METHODS: A retrospective study on 2300 consecutive patients that underwent CABG at Landspítali University Hospital 2001-2020. Patients were divided into four groups according to preoperative estimated glomerular filtration rate (GFR), and the groups compared. GFR 45-59 mL/mín/1.73m2, GFR 30-44 mL/mín/1.73m2, GFR <30 mL/mín/1.73m2 and controls with normal GFR (≥60 mL/mín/1.73m2). Clinical information was gathered from medical records and logistic regression used to estimate risk factors of 30-day mortality.

RESULTS: Altogether 429 (18.7%) patients had impaired kidney function; these patients being more than six years older, having more cardiac symptoms and a higher mean EuroSCORE II (5.0 vs. 1.9, p<0.001) compared to controls. Furthermore, their left ventricular ejection fraction was also lower, their median hospital stay extended by two days and major short-term complications more common, as was 30 day mortality (24.4% vs. 1.4%, p<0.001). In multivariate analysis advanced age, ejection fraction <30% and GFR <30 mL/min/1.73m2 were independent predictors of higher 30-day mortality (OR=10.4; 95% CI: 3.98-25.46).

CONCLUSIONS: Patients with impaired renal function are older and more often have severe coronary artery disease. Early complications and 30-day mortality were much higher in these patients compared to controls and advanced renal failure and the strongest predictor of 30-day mortality.

Translated title of the contribution	Impact of renal dysfunction on early outcomes of coronary artery bypass grafting surgery
Original language	Icelandic
Pages (from-to)	231-237
Number of pages	7
Journal	Læknablaðið
Volume	108
Issue number	5
DOIs	https://doi.org/10.17992/LBL.2022.05.690
Publication status	Published - 6 May 2022

Bibliographical note

Other keywords

Coronary artery bypass grafting (CABG)
chronic kidney disease
complications
outcome
reduced kidney function
short-term

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.17992/LBL.2022.05.690

https://iris.landspitali.is/ws/files/63081256/_hrif_....pdfLicence: Unspecified
https://iris.hi.is/ws/files/63081256/_hrif_....pdfLicence: Unspecified

Cite this

Sveinsdottir, N., Heidarsdottir, S. R., Steinthorsson, A. S., Jóhannesdóttir, H., Heimisdóttir, A. A., Kristjánsson, T. Þ., Long, Þ. E., Guðmundsdóttir, I. J., Sigurðsson, M. I., & Guðbjartsson, T. (2022). Áhrif skertrar nýrnastarfsemi á snemmkominn árangur kransæðahjáveituaðgerða. Læknablaðið, 108(5), 231-237. https://doi.org/10.17992/LBL.2022.05.690

@article{762c1873a7bc464cbd7f9f474bc77663,

title = "{\'A}hrif skertrar n{\'y}rnastarfsemi {\'a} snemmkominn {\'a}rangur krans{\ae}{\dh}ahj{\'a}veitua{\dh}ger{\dh}a",

abstract = "INNGANGUR Skert n{\'y}rnastarfsemi eins og vi{\dh} langvinnan n{\'y}rnasj{\'u}kd{\'o}m er {\'a}h{\ae}ttu{\th}{\'a}ttur krans{\ae}{\dh}asj{\'u}kd{\'o}ms og hefur veri{\dh} tengd vi{\dh} aukna t{\'i}{\dh}ni fylgikvilla og d{\'a}nart{\'i}{\dh}ni eftir krans{\ae}{\dh}ahj{\'a}veitua{\dh}ger{\dh}. {\'A}rangur hj{\'a}veitua{\dh}ger{\dh}a hj{\'a} {\th}essum sj{\'u}klingah{\'o}p hefur ekki veri{\dh} rannsaka{\dh}ur s{\'e}rstaklega h{\'e}r {\'a} landi og er markmi{\dh} ranns{\'o}knarinnar a{\dh} b{\ae}ta {\'u}r {\th}v{\'i}, me{\dh} {\'a}herslu {\'a} snemmkomna fylgikvilla og 30 daga d{\'a}nart{\'i}{\dh}ni. EFNIVI{\DH}UR OG A{\DH}FER{\DH}IR Afturskyggn ferilranns{\'o}kn {\'a} 2300 sj{\'u}klingum sem gengust undir krans{\ae}{\dh}ahj{\'a}veitu {\'a} Landsp{\'i}tala 2001-2020. Sj{\'u}klingunum var skipt {\'i} fj{\'o}ra h{\'o}pa eftir {\'a}{\ae}tlu{\dh}um gaukuls{\'i}unarhra{\dh}a (GSH) reiknu{\dh}um fyrir a{\dh}ger{\dh} og voru h{\'o}parnir bornir saman; GSH 45-59 mL/m{\'i}n/1,73m2, GSH 30-44 mL/m{\'i}n/1,73m2, GSH 60 mL/m{\'i}n/1,73m2). Kl{\'i}n{\'i}skar uppl{\'y}singar fengust {\'u}r sj{\'u}kraskr{\'a}m og l{\'o}gist{\'i}sk a{\dh}hvarfsgreining notu{\dh} til a{\dh} meta forsp{\'a}r{\th}{\ae}tti 30 daga d{\'a}nart{\'i}{\dh}ni. NI{\DH}URST{\"O}{\DH}UR Alls h{\"o}f{\dh}u 429 sj{\'u}klingar (18,7\%) skerta n{\'y}rnastarfsemi og voru {\th}eir r{\'u}mlega sex {\'a}rum eldri a{\dh} me{\dh}altali, einkennameiri, h{\"o}f{\dh}u h{\ae}rra me{\dh}al EuroSCORE II (5,0 {\'a} m{\'o}ti 1,9, p {\'A}LYKTANIR Sj{\'u}klingar me{\dh} skerta n{\'y}rnastarfsemi eru eldri og hafa alvarlegri krans{\ae}{\dh}asj{\'u}kd{\'o}m en {\th}eir sem hafa e{\dh}lilega n{\'y}rnastarfsemi. T{\'i}{\dh}ni snemmkominna fylgikvilla og 30 daga d{\'a}nart{\'i}{\dh}ni {\'i} kj{\"o}lfar krans{\ae}{\dh}ahj{\'a}veitua{\dh}ger{\dh}a reyndist markt{\ae}kt h{\ae}rri hj{\'a} sj{\'u}klingum me{\dh} verstu n{\'y}rnastarfsemina sem jafnframt var sterkasti sj{\'a}lfst{\ae}{\dh}i forsp{\'a}r{\th}{\'a}ttur 30 daga d{\'a}nart{\'i}{\dh}ni. INTRODUCTION: Impaired renal function as seen in chronic kidney disease (CKD) is a known risk factor for coronary artery diseases and has been linked to inferior outcome after myocardial revascularization. Studies on the outcome of coronary bypass grafting (CABG) in CKD-patients are scarce. We aimed to study this subgroup of patients following CABG in a well defined whole-nation cohort, focusing on short term complications and 30 day mortality. MATERIALS AND METHODS: A retrospective study on 2300 consecutive patients that underwent CABG at Landsp{\'i}tali University Hospital 2001-2020. Patients were divided into four groups according to preoperative estimated glomerular filtration rate (GFR), and the groups compared. GFR 45–59 mL/m{\'i}n/1.73m2, GFR 30-44 mL/m{\'i}n/1.73m2, GFR RESULTS: Altogether 429 (18.7\%) patients had impaired kidney function; these patients being more than six years older, having more cardiac symptoms and a higher mean EuroSCORE II (5.0 vs. 1.9, p CONCLUSIONS: Patients with impaired renal function are older and more often have severe coronary artery disease. Early complications and 30-day mortality were much higher in these patients compared to controls and advanced renal failure and the strongest predictor of 30-day mortality.",

keywords = "Coronary Artery Bypass/adverse effects, Coronary Artery Disease/complications, Coronary artery bypass grafting (CABG), Female, Humans, Male, Renal Insufficiency, Chronic/complications, Renal Insufficiency/complications, Retrospective Studies, Stroke Volume, Ventricular Function, Left, chronic kidney disease, complications, outcome, reduced kidney function, short-term, Coronary artery bypass grafting (CABG), chronic kidney disease, complications, outcome, reduced kidney function, short-term",

author = "Nanna Sveinsdottir and Heidarsdottir, \{Sunna Run\} and Steinthorsson, \{Arni Steinn\} and Hera J{\'o}hannesd{\'o}ttir and Heimisd{\'o}ttir, \{Alexandra Ald{\'i}s\} and Kristj{\'a}nsson, \{T{\'o}mas {\TH}{\'o}r\} and Long, \{{\TH}{\'o}rir Einarsson\} and Gu{\dh}mundsd{\'o}ttir, \{Ingibj{\"o}rg J{\'o}na\} and Sigur{\dh}sson, \{Martin Ingi\} and T{\'o}mas Gu{\dh}bjartsson",

year = "2022",

month = may,

day = "6",

doi = "10.17992/LBL.2022.05.690",

language = "{\'I}slenska",

volume = "108",

pages = "231--237",

journal = "L{\ae}knabla{\dh}i{\dh}",

issn = "1670-4959",

publisher = "Icelandic Medical Association",

number = "5",

}

TY - JOUR

T1 - Áhrif skertrar nýrnastarfsemi á snemmkominn árangur kransæðahjáveituaðgerða

AU - Sveinsdottir, Nanna

AU - Heidarsdottir, Sunna Run

AU - Steinthorsson, Arni Steinn

AU - Jóhannesdóttir, Hera

AU - Heimisdóttir, Alexandra Aldís

AU - Kristjánsson, Tómas Þór

AU - Long, Þórir Einarsson

AU - Guðmundsdóttir, Ingibjörg Jóna

AU - Sigurðsson, Martin Ingi

AU - Guðbjartsson, Tómas

PY - 2022/5/6

Y1 - 2022/5/6

N2 - INNGANGUR Skert nýrnastarfsemi eins og við langvinnan nýrnasjúkdóm er áhættuþáttur kransæðasjúkdóms og hefur verið tengd við aukna tíðni fylgikvilla og dánartíðni eftir kransæðahjáveituaðgerð. Árangur hjáveituaðgerða hjá þessum sjúklingahóp hefur ekki verið rannsakaður sérstaklega hér á landi og er markmið rannsóknarinnar að bæta úr því, með áherslu á snemmkomna fylgikvilla og 30 daga dánartíðni. EFNIVIÐUR OG AÐFERÐIR Afturskyggn ferilrannsókn á 2300 sjúklingum sem gengust undir kransæðahjáveitu á Landspítala 2001-2020. Sjúklingunum var skipt í fjóra hópa eftir áætluðum gaukulsíunarhraða (GSH) reiknuðum fyrir aðgerð og voru hóparnir bornir saman; GSH 45-59 mL/mín/1,73m2, GSH 30-44 mL/mín/1,73m2, GSH 60 mL/mín/1,73m2). Klínískar upplýsingar fengust úr sjúkraskrám og lógistísk aðhvarfsgreining notuð til að meta forspárþætti 30 daga dánartíðni. NIÐURSTÖÐUR Alls höfðu 429 sjúklingar (18,7%) skerta nýrnastarfsemi og voru þeir rúmlega sex árum eldri að meðaltali, einkennameiri, höfðu hærra meðal EuroSCORE II (5,0 á móti 1,9, p ÁLYKTANIR Sjúklingar með skerta nýrnastarfsemi eru eldri og hafa alvarlegri kransæðasjúkdóm en þeir sem hafa eðlilega nýrnastarfsemi. Tíðni snemmkominna fylgikvilla og 30 daga dánartíðni í kjölfar kransæðahjáveituaðgerða reyndist marktækt hærri hjá sjúklingum með verstu nýrnastarfsemina sem jafnframt var sterkasti sjálfstæði forspárþáttur 30 daga dánartíðni. INTRODUCTION: Impaired renal function as seen in chronic kidney disease (CKD) is a known risk factor for coronary artery diseases and has been linked to inferior outcome after myocardial revascularization. Studies on the outcome of coronary bypass grafting (CABG) in CKD-patients are scarce. We aimed to study this subgroup of patients following CABG in a well defined whole-nation cohort, focusing on short term complications and 30 day mortality. MATERIALS AND METHODS: A retrospective study on 2300 consecutive patients that underwent CABG at Landspítali University Hospital 2001-2020. Patients were divided into four groups according to preoperative estimated glomerular filtration rate (GFR), and the groups compared. GFR 45–59 mL/mín/1.73m2, GFR 30-44 mL/mín/1.73m2, GFR RESULTS: Altogether 429 (18.7%) patients had impaired kidney function; these patients being more than six years older, having more cardiac symptoms and a higher mean EuroSCORE II (5.0 vs. 1.9, p CONCLUSIONS: Patients with impaired renal function are older and more often have severe coronary artery disease. Early complications and 30-day mortality were much higher in these patients compared to controls and advanced renal failure and the strongest predictor of 30-day mortality.

AB - INNGANGUR Skert nýrnastarfsemi eins og við langvinnan nýrnasjúkdóm er áhættuþáttur kransæðasjúkdóms og hefur verið tengd við aukna tíðni fylgikvilla og dánartíðni eftir kransæðahjáveituaðgerð. Árangur hjáveituaðgerða hjá þessum sjúklingahóp hefur ekki verið rannsakaður sérstaklega hér á landi og er markmið rannsóknarinnar að bæta úr því, með áherslu á snemmkomna fylgikvilla og 30 daga dánartíðni. EFNIVIÐUR OG AÐFERÐIR Afturskyggn ferilrannsókn á 2300 sjúklingum sem gengust undir kransæðahjáveitu á Landspítala 2001-2020. Sjúklingunum var skipt í fjóra hópa eftir áætluðum gaukulsíunarhraða (GSH) reiknuðum fyrir aðgerð og voru hóparnir bornir saman; GSH 45-59 mL/mín/1,73m2, GSH 30-44 mL/mín/1,73m2, GSH 60 mL/mín/1,73m2). Klínískar upplýsingar fengust úr sjúkraskrám og lógistísk aðhvarfsgreining notuð til að meta forspárþætti 30 daga dánartíðni. NIÐURSTÖÐUR Alls höfðu 429 sjúklingar (18,7%) skerta nýrnastarfsemi og voru þeir rúmlega sex árum eldri að meðaltali, einkennameiri, höfðu hærra meðal EuroSCORE II (5,0 á móti 1,9, p ÁLYKTANIR Sjúklingar með skerta nýrnastarfsemi eru eldri og hafa alvarlegri kransæðasjúkdóm en þeir sem hafa eðlilega nýrnastarfsemi. Tíðni snemmkominna fylgikvilla og 30 daga dánartíðni í kjölfar kransæðahjáveituaðgerða reyndist marktækt hærri hjá sjúklingum með verstu nýrnastarfsemina sem jafnframt var sterkasti sjálfstæði forspárþáttur 30 daga dánartíðni. INTRODUCTION: Impaired renal function as seen in chronic kidney disease (CKD) is a known risk factor for coronary artery diseases and has been linked to inferior outcome after myocardial revascularization. Studies on the outcome of coronary bypass grafting (CABG) in CKD-patients are scarce. We aimed to study this subgroup of patients following CABG in a well defined whole-nation cohort, focusing on short term complications and 30 day mortality. MATERIALS AND METHODS: A retrospective study on 2300 consecutive patients that underwent CABG at Landspítali University Hospital 2001-2020. Patients were divided into four groups according to preoperative estimated glomerular filtration rate (GFR), and the groups compared. GFR 45–59 mL/mín/1.73m2, GFR 30-44 mL/mín/1.73m2, GFR RESULTS: Altogether 429 (18.7%) patients had impaired kidney function; these patients being more than six years older, having more cardiac symptoms and a higher mean EuroSCORE II (5.0 vs. 1.9, p CONCLUSIONS: Patients with impaired renal function are older and more often have severe coronary artery disease. Early complications and 30-day mortality were much higher in these patients compared to controls and advanced renal failure and the strongest predictor of 30-day mortality.

KW - Coronary Artery Bypass/adverse effects

KW - Coronary Artery Disease/complications

KW - Coronary artery bypass grafting (CABG)

KW - Female

KW - Humans

KW - Male

KW - Renal Insufficiency, Chronic/complications

KW - Renal Insufficiency/complications

KW - Retrospective Studies

KW - Stroke Volume

KW - Ventricular Function, Left

KW - chronic kidney disease

KW - complications

KW - outcome

KW - reduced kidney function

KW - short-term

KW - Coronary artery bypass grafting (CABG)

KW - chronic kidney disease

KW - complications

KW - outcome

KW - reduced kidney function

KW - short-term

UR - https://www.scopus.com/pages/publications/85129781349

U2 - 10.17992/LBL.2022.05.690

DO - 10.17992/LBL.2022.05.690

M3 - Grein

C2 - 35499246

SN - 1670-4959

VL - 108

SP - 231

EP - 237

JO - Læknablaðið

JF - Læknablaðið

IS - 5

ER -

Áhrif skertrar nýrnastarfsemi á snemmkominn árangur kransæðahjáveituaðgerða

Abstract

Bibliographical note

Other keywords

UN SDGs

Access to Document

Fingerprint

Cite this