Published Online
on November 6, 2006

A more recent version of this article appeared on November 21, 2006

This Article Full Text (PDF) CME: Take the course for this article: Circulation: November 21, 2006, Volume 114, Number 21 All Versions of this Article: 114/21/2208    most recent CIRCULATIONAHA.106.635573v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mehta, R. H. Search for Related Content PubMed PubMed Citation Articles by Mehta, R. H. Pubmed/NCBI databases Medline Plus Health Information Dialysis Heart Surgery Kidney Failure Related Collections CV surgery: coronary artery disease CV surgery: valvular disease Related Article

Submitted on April 22, 2006
Revised on August 21, 2006
Accepted on September 8, 2006

Bedside Tool for Predicting the Risk of Postoperative Dialysis in Patients Undergoing Cardiac Surgery

Rajendra H. Mehta MD, MS^*, Joshua D. Grab MS, Sean M. O’Brien PhD, Charles R. Bridges MD, James S. Gammie MD, Constance K. Haan MD, T. Bruce Ferguson MD, Eric D. Peterson MD, MPH, for the Society of Thoracic Surgeons National Cardiac Surgery Database Investigators

From Duke Clinical Research Institute, Durham, NC (R.H.M., J.D.G., S.M.O., E.D.P.); University of Pennsylvania Health System, Philadelphia (C.R.B.); University of Maryland Medical Center, Baltimore (C.K.H.); University of Florida, Jacksonville (C.K.H.); and Eastern Carolina University, Greenville, NC (T.B.F.).

^* To whom correspondence should be addressed. E-mail: mehta007{at}dcri.duke.edu.

Background--Estimation of an individual patient’s risk for postoperative dialysis can support informed clinical decision making and patient counseling.

Methods and Results--To develop a simple bedside risk algorithm for estimating patients’ probability for dialysis after cardiac surgery, we evaluated data of 449 524 patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery and enrolled in >600 hospitals participating in the Society of Thoracic Surgeons National Database (2002-2004). Logistic regression was used to identify major predictors of postoperative dialysis. Model coefficients were then converted into an additive risk score and internally validated. The model also was validated in a second sample of 86 009 patients undergoing cardiac surgery from January to June 2005. Postoperative dialysis was needed in 6451 patients after cardiac surgery (1.4%), ranging from 1.1% for isolated CABG procedures to 5.1% for CABG plus mitral valve surgery. Multivariable analysis identified preoperative serum creatinine, age, race, type of surgery (CABG plus valve or valve only versus CABG only), diabetes, shock, New York Heart Association class, lung disease, recent myocardial infarction, and prior cardiovascular surgery to be associated with need for postoperative dialysis (c statistic=0.83). The risk score accurately differentiated patients’ need for postoperative dialysis across a broad risk spectrum and performed well in patients undergoing isolated CABG, off-pump CABG, isolated aortic valve surgery, aortic valve surgery plus CABG, isolated mitral valve surgery, and mitral valve surgery plus CABG (c statistic=0.83, 0.85, 0.81, 0.75, 0.80, and 0.75, respectively).

Conclusions--Our study identifies the major patient risk factors for postoperative dialysis after cardiac surgery. These risk factors have been converted into a simple, accurate bedside risk tool. This tool should facilitate improved clinician-patient discussions about risks of postoperative dialysis.

Key words: coronary disease • dialysis • risk factors • surgery • valves

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