Abstract: PO2103
Outcomes of Cardiac Surgery in CKD Stage 3 vs. Stage 4 and 5
Session Information
- CVD, BP, and Kidney Diseases: Exploring the Link
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
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
| Factor | N missing | Stage 3 (N=873) | Stage 4 or 5 (N=115) | p-value | |
| N ICU days | 11 | 4.0[3.0,7.0] | 5.0[3.0,11.0] | <0.001b | |
| Pressor days >3 (P50) | 201 | 218(32.0) | 49(46.7) | 0.003c | |
| Intubation days >2 (P50) | 58 | 166(20.2) | 36(32.7) | 0.003c | |
| Post AKID during admission | 0 | 42(4.8) | 24(20.9) | <0.001c | |
| In-Hospital Death | 0 | 32(3.7) | 5(4.3) | 0.72c | |
| Post-op LOS | 0 | 9.0[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