The effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting
| Autor: | Benjamin Medalion, Abid Assali, Ran Kornowski, Philip Biderman, Ariel Farkash, Eitan Snir, Hana Vaknin Assa, Gai Milo, Erez Sharoni, Eyal E Porat, Alexander Battler, Hilit Cohen |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors medicine.medical_treatment Contrast-induced nephropathy Contrast Media Renal function Coronary Angiography Kidney Function Tests Preoperative care law.invention law Internal medicine Preoperative Care Prevalence medicine Humans Coronary Artery Bypass Dialysis Aged Retrospective Studies medicine.diagnostic_test business.industry Acute kidney injury Acute Kidney Injury medicine.disease Intensive care unit Cardiac surgery Angiography Cardiology Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 139:1539-1544 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2009.08.042 |
| Popis: | ObjectiveOur objective was to assess the effect of the timing of cardiac angiography, contrast media dose, and preoperative renal function on the prevalence of acute renal failure after cardiac surgery.MethodsData on 395 consecutive patients who underwent coronary artery bypass grafting were prospectively collected. Creatinine clearance was estimated by the Cockcroft–Gault equation. Patients were divided into 3 groups according to the time between cardiac angiography and surgery (group A, ≤ 1 day; group B, > 1 day and ≤ 5 days; group C, > 5 days). Patients who underwent a salvage operation or were receiving dialysis before surgery were excluded. Acute renal failure was defined as 25% decrease from baseline of estimated creatinine clearance and estimated creatinine clearance of 60 mL/min or less on postoperative day 3. Owing to differences in preoperative characteristics between groups, propensity score analysis was used to adjust those differences.ResultsAcute renal failure developed in 13.6% of patients. Hospital mortality was 3.3% and was higher in patients in whom acute renal failure developed (22%) versus those in whom it did not (0.3%; P < .001). Multivariable analysis identified preoperative estimated creatinine clearance of 60 mL/min or less (odds ratio [OR], 7.1), operation within 24 hours of catheterization (OR = 3.7), use of more than 1.4 mL/kg of contrast media (OR = 3.4), lower hemoglobin level (OR = 1.3), older age (OR = 1.1), and lower weight (OR = 0.95) as independent predictors of postoperative acute renal failure. Analysis of interaction between contrast dose and time of surgery revealed that high contrast dose (>1.4 mL/kg) predicted acute renal failure if surgery was performed up to 5 days after angiography.ConclusionsWhenever possible, coronary bypass grafting should be delayed for at least 5 days in patients who received a high contrast dose, especially if they also have preoperative reduced renal function. |
| Databáze: | OpenAIRE |
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