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Nephrology - Non-Clinical Medicine - Physiology - Surgery - Urology


Preoperative Proteinuria Is Associated with Long-Term Progression to Chronic Dialysis and Mortality after Coronary Artery Bypass Grafting Surgery
Published: Friday, January 20, 2012
Author: Vin-Cent Wu et al.

by Vin-Cent Wu, Tao-Min Huang, Pei-Chen Wu, Wei-Jie Wang, Chia-Ter Chao, Shao-Yu Yang, Chih-Chung Shiao, Fu-Chang Hu, Chun-Fu Lai, Yu-Feng Lin, Yin-Yi Han, Yih-Sharng Chen, Ron-Bin Hsu, Guang-Huar Young, Shoei-Shen Wang, Pi-Ru Tsai, Yung-Ming Chen, Ting-Ting Chao, Wen-Je Ko, Kwan-Dun Wu, the NSARF Group

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.

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