Wang Wuwei, Cao Xu, Wu Yukai, Liu Quan, Zhou Yifei, Fan Rui, Chen Xin, Wang Rui
Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
School of Medicine, Southeast University, Nanjing, China.
Ren Fail. 2025 Dec;47(1):2539944. doi: 10.1080/0886022X.2025.2539944. Epub 2025 Aug 7.
Renal dysfunction is the most common risk factor for patients with coronary artery bypass grafting (CABG). The aim of this research was to evaluate the prognosis and mid-term outcomes in CABG patients with mild renal dysfunction.
Patients undergoing isolated CABG from July 2020 to December 2022 in Nanjing First Hospital were selected into this cohort study and divided into normal renal function group (eGFR ≥ 90 mL/min/1.73 m, corresponding to CKD G1) and mild renal dysfunction group (eGFR: 60-89 mL/min/1.73 m, corresponding to CKD G2). Propensity score matching was used to balance the differences. The primary outcomes were acute kidney injury (AKI) and all-cause mortality in follow-up, while the secondary outcomes were perioperative mortality and major adverse cardiac and cerebrovascular event (MACCE) including death, stroke, myocardial infarction, and revascularization.
Totally 1,097 patients were enrolled in this study and 416 (33.3%) had mild renal dysfunction. A total of 379 pairs were included to the analysis after propensity score matching. Compared with the normal renal function, patients with mild renal dysfunction had more AKI after CABG (26.1% vs. 18.7%, = 0.015), however, the perioperative mortality (1.3% vs. 1.3%, = 1.00) was not significantly different. At 3-year follow-up, there were also no significant differences in all-cause mortality (6.3% vs. 4.8%, log-rank = 0.33, HR 1.38, 95%CI: 0.721-2.652) and MACCE rates (10.2% vs. 7.6%, log-rank = 0.19, HR 1.42, 95%CI: 0.836-2.414).
For patients undergoing CABG, preoperative renal dysfunction is associated with an increased risk of postoperative AKI. However, no significant difference was observed in perioperative mortality and mid-term outcomes.
肾功能不全是冠状动脉旁路移植术（CABG）患者最常见的危险因素。本研究旨在评估轻度肾功能不全的CABG患者的预后和中期结局。
选取2020年7月至2022年12月在南京第一医院接受单纯CABG的患者纳入本队列研究，分为肾功能正常组（eGFR≥90 mL/min/1.73 m²，对应CKD G1期）和轻度肾功能不全组（eGFR：60 - 89 mL/min/1.73 m²，对应CKD G2期）。采用倾向得分匹配法平衡差异。主要结局为随访期间的急性肾损伤（AKI）和全因死亡率，次要结局为围手术期死亡率和主要不良心脑血管事件（MACCE），包括死亡、中风、心肌梗死和血运重建。
本研究共纳入1097例患者，其中416例（33.3%）有轻度肾功能不全。倾向得分匹配后共纳入379对进行分析。与肾功能正常者相比，轻度肾功能不全患者CABG术后发生AKI的比例更高（26.1%对18.7%，P = 0.015），然而围手术期死亡率（1.3%对1.3%，P = 1.00）无显著差异。在3年随访时，全因死亡率（6.3%对4.8%，log-rank P = 0.33，HR 1.38，95%CI：0.721 - 2.652）和MACCE发生率（10.2%对7.6%，log-rank P = 0.19，HR 1.42，95%CI：0.836 - 2.414）也无显著差异。
对于接受CABG的患者，术前肾功能不全与术后AKI风险增加相关。然而，围手术期死亡率和中期结局未观察到显著差异。
