5.2 End-stage renal failure
It is demonstrated that a dose-dependent relationship exists between increased severity of AKI and increased ESRD incidence among cardiac surgery patients.31 Of note, small changes in postoperative s-Cr levels resulted in up to a 4-fold increase in long-term ESRD risk. A study by Ryden et al found that patients with reduced preoperative eGFR are associated with a higher absolute risk of ESRD after CABG procedure. Other known factors that predispose ESRD development includes lower left ventricular ejection fraction, previous stroke, myocardial infarction, and heart failure. 32Not only is diabetes mellitus is one of the principal causes of ESRD, but the trajectory of ESRD is also rapid; within 5 years, among diabetic patients who develop AKI postoperatively 33
Minimizing complications
Considering the significant renal complications associated with cardiac surgeries, several clinical trials have been conducted in attempts to manage risk factors appropriately and evaluate medical interventions, to improve both short-term and long-term kidney outcomes.41