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

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)857-864
Number of pages8
JournalMayo Clinic Proceedings
Volume90
Issue number7
DOIs
StatePublished - Jul 1 2015

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ASJC Scopus subject areas

  • Medicine(all)

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Thongprayoon, C., Cheungpasitporn, W., Shah, I. K., Kashyap, R., Park, S. J., Kashani, K., & Dillon, J. J. (2015). Long-term Outcomes and Prognostic Factors for Patients Requiring Renal Replacement Therapy After Cardiac Surgery. Mayo Clinic Proceedings, 90(7), 857-864. https://doi.org/10.1016/j.mayocp.2015.03.026