PRE-OPERATIVE KIDNEY DISEASE & POST-OPERATIVE MORTALITY FOR CORONARY ARTERY BYPASS GRAFTING IN AUSTRALIA 2001-2019
Dominic Keuskamp1,2, CHRISTOPHER E DAVIES1,2, ROBERT A BAKER3,4, KEVAN R POLKINGHORNE5,6, CHRISTOPHER E REID6,7,8, JULIAN A SMITH8,9,10, LAVINIA TRAN6,8, JENNI WILLIAMS-SPENCE6,8, RORY WOLFE6, STEPHEN P MCDONALD1,2,11 1Australia & New Zealand Dialysis & Transplant Registry, South Australian Health & Medical Research Institute, Adelaide, SA, Australia2Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA, Australia3College of Medicine & Public Health, Flinders University, Bedford Park, SA, Australia4Cardiac Surgery Quality & Outcomes Department, Flinders Medical Centre, Bedford Park, SA, Australia5Department of Nephrology, Monash Health, Clayton, VIC, Australia6School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia7School of Population Health, Curtin University, Bentley, WA, Australia8Australian & New Zealand Society of Cardiac & Thoracic Surgeons (ANZSCTS) Cardiac Surgery Database, Monash University, Melbourne, VIC, Australia9Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, VIC, Australia10Department of Cardiothoracic Surgery, Monash Health, Clayton, VIC, Australia11Central & Northern Adelaide Renal & Transplantation Services, Royal Adelaide Hospital, Adelaide, SA, Australia
Abstract
Aim: To describe the impact of different stages of kidney disease on mortality following isolated coronary artery bypass graft (CABG) surgery, and trends across these groups over two decades.
Background: Kidney disease increases adults’ risk of cardiovascular disease, sometimes requiring cardiac surgery. Post-operative mortality risks for these patients are not widely known.
Methods: Data were linked probabilistically between the Australia & New Zealand Dialysis & Transplant Registry and the Australian & New Zealand Society of Cardiac & Thoracic Surgeons Cardiac Surgery Database. Risk of 30-day mortality, adjusted for factors drawn from an independently validated mortality risk prediction model (AusScore II), was compared for cohorts of differing kidney function (defined by preoperative eGFR / short-term dialysis / maintenance dialysis) using multivariable logistic regression. All eligible surgeries from 2001-2019 were included (n= 81,712).
Results:
Unadjusted mortality increased with increasing level of kidney disease from 0.90% (eGFR 60 to 89 ml/min/1.73 m²) to 4.5% (maintenance dialysis), compared to 0.44% for patients with normal function (eGFR ≥ 90 ml/min/1.73 m²). Following adjustment, mortality risk remained elevated for all patients with kidney disease, especially those receiving maintenance dialysis (OR 6.5, 95% CI 4.3-9.6), compared to patients with normal kidney function. Assessment restricted to maintenance dialysis patients revealed no association between mortality and vintage. The mortality rate declined for all groups across the study period (OR 0.98, 0.97-0.99) and there was no significant difference in this rate of change over time by kidney disease.
Conclusions: Adults with pre-operative kidney disease, especially those receiving maintenance dialysis, experienced higher mortality than patients with normal kidney function following isolated CABG surgery in 2001-2019. The mortality rate declined for all groups across the study period.
Biography
Dr Dominic Keuskamp is a Postdoctoral Research Fellow with the Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry at the South Australian Health & Medical Research Institute. His work is focussed on using data from the registry and from linkage to other sources to answer questions related to the predictors and outcomes of kidney failure treated with kidney replacement therapy. Additional work includes retrospective and prospective analyses of dialysis demand to inform health service planning and advocacy.