Long-term Outcomes and Prognostic Factors for Patients Requiring Renal Replacement Therapy After Cardiac Surgery

Charat Thongprayoon, Wisit Cheungpasitporn, Ishan K Shah, Rahul Kashyap, Soon J Park, Kianoush Kashani, John J Dillon
Mayo Clinic Proceedings 2015, 90 (7): 857-64

OBJECTIVE: To examine long-term outcomes, including all-cause mortality, and the likelihood and timing of renal recovery among patients requiring renal replacement therapy (RRT) for acute kidney injury after cardiac surgery.

PATIENTS AND METHODS: This is a single-center, historical, matched cohort study of post-cardiac surgery patients who required RRT from January 1, 2007, through December 31, 2012. We matched each case with 2 controls, each of whom did not require RRT after cardiac surgery, for age, sex, and type of surgery. The patients were followed up for 1 year after the start of RRT. The main outcomes were all-cause mortality in all patients and rate of renal function recovery in patients who required RRT.

RESULTS: A total of 202 patients met the inclusion criteria. The unadjusted all-cause mortality among patients requiring RRT was 64% at 1 year vs 8% for matched controls. In multivariate analysis, the hazard ratio for all-cause mortality was 12.59 (95% CI, 8.24-19.68) for cases vs controls. Increased 1-year all-cause mortality was independently associated with increased age, a history of congestive heart failure, lower preoperative creatinine level, longer interval between surgery and starting RRT, and the need for mechanical ventilation or an intra-aortic balloon pump at the time of RRT. Renal recovery occurred in 34% of cases by 90 days and in 39% by 1 year. Of those who recovered renal function, 87% were within 90 days. Only 8 (4%) of the 186 patients were alive and continued to receive RRT at 1 year.

CONCLUSIONS: The need for RRT after cardiac surgery is an independent risk factor for mortality. In the case of survival, the chance of renal recovery is reasonable.

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