BACKGROUND: Renal failure (RF) represents a major postoperative complication for elderly patients undergoing cardiac surgery. This observational cohort study examines effects of preoperative use of renin-angiotensin system (RAS) inhibitors on postoperative renal failure in aging patients undergoing cardiac surgery. METHODS AND RESULTS: We retrospectively analyzed a cohort of 1287 patients who underwent cardiac surgery at this institution (2003-2007). The patients included were ≥65 years old, scheduled for elective cardiac surgery, and without preexisting RF (defined by the criteria of the Society of Thoracic Surgeons as described in Method). Of all patients evaluated, 346 patients met the inclusion criteria and were divided into two groups: using (n = 122) or not using (n = 224) preoperative RAS inhibitors. A comparison of the two groups showed no significant differences in baseline parameters, including creatinine clearance, body mass index, history of diabetes and smoking, preoperative medicines (except that more patients with RAS inhibitors had a history of hypertension or congestive heart failure, fewer RAS inhibitor patients had chronic lung disease), in intraoperative perfusion and aortic cross-clamp time, and in postoperative complications and 30-d mortality. Multivariate logistic regression analysis demonstrated, however, that preoperative RAS inhibitors significantly and independently reduced the incidence of postoperative RF in the patients undergoing cardiac surgery compared with those not taking RAS inhibitors: 1.6% versus 7.6%, yielding an odds ratio of 0.19 (95 % CI 0.04-0.84, P = 0.029). CONCLUSIONS: Preoperative RAS inhibitors may have significant renoprotective effects for aging patients undergoing elective cardiac surgery.
BACKGROUND:Renal failure (RF) represents a major postoperative complication for elderly patients undergoing cardiac surgery. This observational cohort study examines effects of preoperative use of renin-angiotensin system (RAS) inhibitors on postoperative renal failure in aging patients undergoing cardiac surgery. METHODS AND RESULTS: We retrospectively analyzed a cohort of 1287 patients who underwent cardiac surgery at this institution (2003-2007). The patients included were ≥65 years old, scheduled for elective cardiac surgery, and without preexisting RF (defined by the criteria of the Society of Thoracic Surgeons as described in Method). Of all patients evaluated, 346 patients met the inclusion criteria and were divided into two groups: using (n = 122) or not using (n = 224) preoperative RAS inhibitors. A comparison of the two groups showed no significant differences in baseline parameters, including creatinine clearance, body mass index, history of diabetes and smoking, preoperative medicines (except that more patients with RAS inhibitors had a history of hypertension or congestive heart failure, fewer RAS inhibitor patients had chronic lung disease), in intraoperative perfusion and aortic cross-clamp time, and in postoperative complications and 30-d mortality. Multivariate logistic regression analysis demonstrated, however, that preoperative RAS inhibitors significantly and independently reduced the incidence of postoperative RF in the patients undergoing cardiac surgery compared with those not taking RAS inhibitors: 1.6% versus 7.6%, yielding an odds ratio of 0.19 (95 % CI 0.04-0.84, P = 0.029). CONCLUSIONS: Preoperative RAS inhibitors may have significant renoprotective effects for aging patients undergoing elective cardiac surgery.
Authors: Steven G Coca; Amit X Garg; Madhav Swaminathan; Susan Garwood; Kwangik Hong; Heather Thiessen-Philbrook; Cary Passik; Jay L Koyner; Chirag R Parikh Journal: Nephrol Dial Transplant Date: 2013-09-29 Impact factor: 5.992
Authors: Mitra K Nadim; Lui G Forni; Azra Bihorac; Charles Hobson; Jay L Koyner; Andrew Shaw; George J Arnaoutakis; Xiaoqiang Ding; Daniel T Engelman; Hrvoje Gasparovic; Vladimir Gasparovic; Charles A Herzog; Kianoush Kashani; Nevin Katz; Kathleen D Liu; Ravindra L Mehta; Marlies Ostermann; Neesh Pannu; Peter Pickkers; Susanna Price; Zaccaria Ricci; Jeffrey B Rich; Lokeswara R Sajja; Fred A Weaver; Alexander Zarbock; Claudio Ronco; John A Kellum Journal: J Am Heart Assoc Date: 2018-06-01 Impact factor: 5.501
Authors: Shaojie Chen; Willem-Jan Acou; Marcio G Kiuchi; Christian Meyer; Philipp Sommer; Martin Martinek; Alexandra Schratter; Bruno R Andrea; Zhiyu Ling; Shaowen Liu; Yuehui Yin; Gerhard Hindricks; Helmut Pürerfellner; Mitchell W Krucoff; Boris Schmidt; K R Julian Chun Journal: JAMA Netw Open Date: 2019-05-03
Authors: Mitesh Shah; Arsh K Jain; Steven M Brunelli; Steven G Coca; Philip J Devereaux; Matthew T James; Jin Luo; Amber O Molnar; Marko Mrkobrada; Neesh Pannu; Chirag R Parikh; Michael Paterson; Salimah Shariff; Ron Wald; Michael Walsh; Richard Whitlock; Duminda N Wijeysundera; Amit X Garg Journal: BMC Nephrol Date: 2014-04-02 Impact factor: 2.388