Preoperative proteinuria is associated with long-term progression to chronic dialysis and mortality after coronary artery bypass grafting surgery
Journal
PLoS ONE
Journal Volume
7
Journal Issue
1
Date Issued
2012
Author(s)
Wang W.-J.
Wang W.-J.
Shiao C.-C.
Lai C.-F.
Young G.-H.
Tsai P.-R.
Chao T.-T.
Ko W.-J.
Abstract
Aims: Preoperative proteinuria is associated with post-operative acute kidney injury (AKI), but whether it is also associated with increased long- term mortality and end -stage renal disease (ESRD) is unknown. Methods and Results: We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+) or heavy (2+ to 4+) according to the results of the dipstick test. A total of 276 (29.8%) patients had mild proteinuria before surgery and 119 (12.9%) patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17) was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88) and heavy proteinuria ([HR], 2.28) to predict all-cause mortality compared to no proteinuria. Mild ([HR], 2.57) and heavy proteinuria ([HR], 2.70) exhibited a stepwise increased ratio compared to patients without proteinuria for long-term composite catastrophic outcomes (mortality and ESRD), which were independent of the baseline GFR and postoperative acute kidney injury (AKI). Conclusion: Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients. ? 2012 Wu et al.
SDGs
Other Subjects
acute kidney failure; adult; adverse outcome; article; causal attribution; comorbidity; coronary artery bypass graft; disease association; disease severity; female; follow up; glomerulus filtration rate; human; long term care; major clinical study; male; mortality; preoperative period; proteinuria; risk assessment; risk factor; coronary artery bypass graft; postoperative complication; prospective study; proteinuria; renal replacement therapy; Adult; Coronary Artery Bypass; Female; Humans; Male; Postoperative Complications; Preoperative Period; Prospective Studies; Proteinuria; Renal Dialysis; Young Adult
Type
journal article