CORONARY-ARTERY BYPASS-GRAFTING IN PATIENTS WITH NON-DIALYSIS-DEPENDENT RENAL-INSUFFICIENCY

Background Preoperative renal failure increases the morbidity and mort ality of coronary artery bypass graft (CABG) surgery. The results of C ABG in patients with non-dialysis-dependent, mild renal insufficiency are unknown. Methods From a population of 2978 consecutive patients un dergoing isolated CABG from 1990 to 1996, 38 patients with preoperativ e renal insufficiency (Renal group; serum creatinine >150 mu mol/L) we re identified and matched on six prognostic variables to a cohort of 1 52 control patients (Control group). Two patients with preoperative di alysis-dependent renal failure were excluded from analysis. Results Co mpared to the overall population, the Renal group were more likely to be over age 70, diabetic, hypertensive, and suffer from peripheral vas cular disease and left ventricular dysfunction. Compared to the Contro l group, the Renal group were more likely to require perioperative blo od transfusions (P<.001) and had a greater requirement for postoperati ve dialysis (P<.01). The Renal group had longer ventilation times, int ensive care unit stay, and postoperative hospital stay. Mild renal ins ufficiency was found to be an independent predictor of postoperative l ow output syndrome (odds ratio=3.6). Conclusions Mild renal insufficie ncy, even in the absence of dialysis, increases the risk of blood tran sfusion, low output syndrome and prolonged the length of intensive car e unit and postoperative stay for patients undergoing CABG.