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Objective: Preoperative renal dysfunction is an established risk factor for early and late mortality after revascularization.
We studied how renal function affects long-term survival of patients after coronary artery bypass
grafting.
Methods: Early and late mortality were determined retrospectively among consecutive patients having isolated
coronary bypass at a single Dutch institution between January 1998 and December 2007. Patients were stratified
into 4 groups according to preoperative renal function. Expected survival was gauged using a general Dutch population
group that was obtained from the database of the Dutch Central Bureau for Statistics; for each of our renal
function groups, a general population group was assembled by matching for age, gender, and year of operation.
Results: After excluding 122 patients lost to follow-up, 10,626 patients were studied; in 10,359, preoperative
creatinine clearance could be calculated. Multivariate logistic regression and Cox regression analysis identified
renal dysfunction as a predictor for early and late mortality. When long-term survival of patient groups was compared
with expected survival, only patients with a creatinine clearance less than 30 mL $ min1 showed a worse
outcome. Patients with a creatinine clearance between 60 and 90 mL $ min1 had a long-term survival exceeding
the expected survival.
Conclusions: Severity of renal dysfunction was related to poor survival.When compared with expected survival,
however, patients having coronary bypass had a worse outcome only when severe preoperative renal dysfunction
was present.
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