eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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SCImago Journal & Country Rank
2/2015
vol. 11
 
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abstract:

Letter to the Editor
Chronic kidney disease in patients with significant left main coronary artery disease qualified for coronary artery bypass graft operation

Malgorzata Zalewska-Adamiec
,
Hanna Bachorzewska-Gajewska
,
Jolanta Malyszko
,
Jacek S. Malyszko
,
Pawel Kralisz
,
Anna Tomaszuk-Kazberuk
,
Tomasz Hirnle
,
Slawomir Dobrzycki

Arch Med Sci 2015; 11, 2: 446–452
Online publish date: 2015/04/23
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According to the guidelines and experts’ opinion, chronic kidney disease can be diagnosed when estimated glomerular filtration rate (eGFR) is lower than 60 ml/min/1.73 m2 and such a filtration rate lasts for more than 3 months. Impaired kidney function accelerates the progress of atherosclerosis, significantly increases the risk of adverse cardiovascular events and worsens prognosis in patients with cardiac diseases. This risk increases in patients with slightly decreased renal function but increases drastically in patients on regular dialysis [1–3].
According to epidemiological data, the rate of chronic kidney disease is growing steadily. About 11% of the population in the United States and Australia have eGFR < 60 ml/min/1.73 m2. In Poland, 10–13% of the general population suffer from chronic kidney disease [4–7].
Among the patients hospitalized due to coronary artery disease (CAD), 5–7% are diagnosed with left main disease (LMD), the most severe form of CAD. Patients with LMD require urgent revascularization, either a coronary artery bypass graft (CABG) operation or percutaneous coronary intervention (PCI) [8]. Presence of chronic kidney disease in these patients may increase the risk of complications and mortality connected with cardiac operation. After coronary angiography and PCI contrast-induced acute kidney injury (CI-AKI) is more frequently observed. It was also observed that in-hospital and late mortality are higher in patients with CI-AKI [9, 10]. Cardiac operation in the group with chronic kidney disease correlates with higher mortality and higher risk of acute kidney injury which requires dialysis [11].
All popular surgical scores take into account serum concentration of creatinine as a factor influencing operative risk. Nevertheless, the correlation between concentration of creatinine and eGFR is not linear. Patients with impaired renal function may have normal creatinine concentration in serum. Estimated glomerular filtration rate is crucial in precise assessment of kidney function, especially in high cardiovascular risk patients such as individuals with LMD treated with CABG [12].
The aim of the study was to assess the prevalence of chronic kidney disease evaluated by eGFR in patients with LMD and its impact on 30-day prognosis after CABG.
During 2 years (2006–2008) 5000 patients underwent coronary angiography in the Department of Invasive Cardiology in Bialystok, Poland. We...


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