Background: The risk factors present in patients with coronary artery disease (CAD) are also present in patients with chronic kidney disease (CKD). Patients who will undergo myocardial revascularization with the use of coronary artery bypass surgery (CAB G) and percutaneous coronary intervention (PCI) have the risk of further deterioration of their kidney function.
Methods: The study was a retrospective cohort. The charts of 259 patients (122 in the CABG group and 137 in the PCI group) were reviewed. The patients who were included are those who are diagnosed with CAD and pre-existing CKD. The baseline variables that were determined prior to each procedure were creatinine, creatinine clearance, age, weight, blood pressure, heart rate, left ventricular end diastolic diameter, presence of hypertension, diabetes mellitus, smoking and history of myocardial infarction. The post- operative variables that were determined were serum creatinine, creatinine clearance, magnitude of increase of creatinine and decrease of creatinine clearance, occurrence of fluid overload, oliguria, anuria and need for post-operative dialysis. Other variables that were determined were serum potassium, sodium and ionized calcium.
Results: There is no significant difference in terms of age, weight, baseline serum creatinine level, glomerular filtration rate (GFR), blood pressure and ejection fraction. There is a significantly more number of males in the CABG group and there are more diabetic patients in the PCI group. There is higher incidence of acute kidney injury among the patients who underwent CABG compared to PCI (64.75% vs. 34.31 %; P<0.001). The incidence of oliguria in the CABG group is higher compared to the PCI group (43.44% vs. 29.93%; P=0.028). The 24 hours and 48 hour post-operative serum creatinine level as well as glomerular filtration rates were similar in both groups. The rate of need for hemodialysis after the procedure were similar for each group as well as the in hospital mortality rate.
Conclusion: There is significantly higher incidence of AKI in patients with CKD after undergoing CABG compared to PCI. This is reflected by the significantly higher incidence of oliguria among patients who underwent CABG.