Trends in Acute Kidney Injury, Associated Use of Dialysis, and Mortality After Cardiac Surgery, 1999 to 2008

被引:75
作者
Lenihan, Colin R.
Montez-Rath, Maria E.
Mangano, Christina T. Mora
Chertow, Glenn M.
Winkelmayer, Wolfgang C.
机构
[1] Stanford Univ, Sch Med, Dept Med, Div Nephrol, Palo Alto, CA 94304 USA
[2] Stanford Univ, Sch Med, Dept Anesthesia, Div Cardiovasc Anesthesia, Palo Alto, CA 94304 USA
关键词
ACUTE-RENAL-FAILURE; BYPASS GRAFT-SURGERY; OFF-PUMP; ON-PUMP; REQUIRING DIALYSIS; UNITED-STATES; RISK; APROTININ; OUTCOMES; REVASCULARIZATION;
D O I
10.1016/j.athoracsur.2012.05.131
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. The development of acute kidney injury (AKI) after cardiac surgery is associated with significant mortality, morbidity, and cost. The last decade has seen major changes in the complexity of cardiac surgical candidates and in the number and type of cardiac surgical procedures being performed. Methods. Using data from the Nationwide Inpatient Sample, we determined the annual rates of AKI, AKI requiring dialysis (AKI-D), and inpatient mortality after cardiac surgery in the United States in the years 1999 through 2008. Results. Inpatient mortality with AKI and AKI-D decreased from 27.9% and 45.9%, respectively, in 1999 to 12.8% and 35.3%, respectively, in 2008. Compared with 1999, the odds of AKI and AKI-D in 2008, adjusted for demographic and clinical factors, were 3.30 (95% confidence interval [CI]: 2.89 to 3.77) and 2.23 (95% CI: 1.78 to 2.80), respectively. Corresponding adjusted odds of death associated with AKI and AKI-D were 0.31 (95% CI: 0.26 to 0.36) and 0.47 (95% CI: 0.34 to 0.65.) Taken together, the attributable risks for death after cardiac surgery associated with AKI and AKI-D increased from 30% and 5%, respectively, in 1999 to 47% and 14%, respectively, in 2008. Conclusions. In sum, despite improvements in individual patient outcomes over the decade 1999 to 2008, the population contribution of AKI and AKI-D to inpatient mortality after surgery increased over the same period. (Ann Thorac Surg 2013;95:20-8) (C) 2013 by The Society of Thoracic Surgeons
引用
收藏
页码:20 / 28
页数:9
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