AKI with major complications linked to decreased survival following coronary artery bypass grafting
WASHINGTON — Acute kidney injury in association with major complications was linked with decreased survival in patients who have undergone coronary artery bypass grafting, according to data presented at ASN Kidney Week.
“We know that AKI has been associated with adverse outcomes following coronary artery bypass grafting (CABG) and, in previous studies, AKI has always been an independent predictor of survival,” Dadi Helgason, MD, PhD, fellow in training at Landspitali University Hospital in Reykjavik, Iceland, told Healio Nephrology. “But we wanted to see why these patients are dying.”
Helgason and colleagues performed a retrospective study of 1,710 patients who underwent CABG from 2001 to 2013. Patients were split into four groups including AKI with or without major complications and non-AKI with or without major complications. Investigators defined AKI by KDIGO criteria and identified major postoperative complications, such as reoperation, stroke, myocardial infarction, mediastinitis, sternum dehiscence, multiple organ failure and acute respiratory distress syndrome.
Overall survival was found to be lower in patients with AKI vs. patients without AKI, with major complications occurring in 21% of the AKI group and in 10% of patients in the non-AKI group. Similarly, adjusted analysis showed patients with AKI and major complications (OR = 30.3) as well as patients without non-AKI but who had major complications (OR = 11.6) had a higher risk of 30-day mortality than the non-AKI group without major complications. However, the risk of death in patients with AKI but without major complications did not significantly increase (OR = 3.4), suggesting a link between concurrent major complications and early mortality.
“When we looked at the four groups, AKI patients without other major complications were not at significant risk of 30-day mortality in the adjusted model.” Helgason said. “This study shows that it's maybe not the AKI itself in isolation that causes the mortality, [but] more the association with other major complications.” – by Eamon Dreisbach
Helgason D, et al. Abstract TH-PO072. Presented at: ASN Kidney Week; Nov. 7-10, 2019; Washington, D.C.
Disclosure: Helgason reports no relevant financial disclosures.