Acute Renal Failure Following Off-pump Coronary Artery Bypass Surgery (OPCAB): Incidence, Risk Factors, and Outcomes / 대한신장학회지

ABSTRACT

PURPOSE: Off-pump coronary artery bypass (OPCAB) is known to be associated with a lower risk of acute renal failure (ARF) than on-pump method. However, little data is available on ARF in OPCAB. The aim of the present study was to identify the incidence, risk factors, and mortality of ARF in OPCAB. METHODS: Perioperative variables in medical records of 573 patients who had undergone OPCAB from Jan 2000 to June 2004 were evaluated. ARF was defined as a 50% increase in preoperative serum creatinine (over 1.4 mg/dL) within 72 hours after operation, or as the need for postoperative dialysis. RESULTS: The incidence of ARF and ARF requiring dialysis were 9.8% and 2.6%, respectively. The independent risk factors for ARF after OPCAB were the perioperative use of an intra-aortic balloon pump (OR, 4.425; 95% CI, 2.342-8.403), high preoperative serum creatinine (OR 2.099; 95% CI, 1.422-3.098), diabetes (OR, 1.961; 95% CI, 1.078-3.571), and old age (OR, 1.479; 95% CI, 1.034- 2.116). The in-hospital mortality rate was 53.3% for patients requiring dialysis, 19.6% for all ARF patients and 0.8% for patients without ARF (p<0.001). The 3-year cumulative mortality rate was 38.4 % in all ARF patients and 5.2% in patients without ARF (p<0.001). CONCLUSION: ARF was not an uncommon complication in adults who underwent OPCAB. Perioperative hemodynamic instability, preoperative renal dysfunction, diabetes, and age could independently predict the development of ARF after OPCAB and the severity of ARF was related to higher in-hospital and long-term mortality rates.