LONG-TERM IMPACT OF CHRONIC KIDNEY DISEASE ON CLINICAL OUTCOMES OF PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING

Background and Aim: Chronic kidney disease (CKD) is one of the major comorbidities in patients undergoing coronary artery bypass grafting (CABG). Its effect on adverse events after surgery is well established, however, the impact of CKD even at early stages on long-term outcomes after CABG is unclear. Methods: We analyze 4493 patients who underwent isolated CABG between 2005 and 2018. They were divided into five classes according to the KDIGO definition based on eGFR. Record linkage with the NHIS codes allowed identification of long-term outcomes. Results: There was a clear trend of worsening risk profile in patients from Class 1 to 4, while Class 5 showed a reverse pattern, most likely reflecting a prevalent primary end-stage renal disease (ESRD). There was no significant difference in intra-operative variables from classes 1 to 5. Short-term postoperative outcomes progressively declined from class 1 to 4, with class 5 presenting less overall complications. On the other hand, patients in class 5 had a significantly higher 30-day mortality. At 5 and 10 years follow-up, we observed an overall survival decreasing from Class 1 to 3 ( p <0.001). Accordingly, Classes 4 and 5 showed dramatically worse long-term survival (49%-21% and 41%-18% respectively, p =n.s.). Classes 4 and 5 did not show a statistically significant difference in the rate of MACCE when compared to Classes 1-3. Conclusion: In our experience, The dramatic decrease in survival for ESRD patients can be attributed to the natural history the disease. Further studies are warranted to better clarify the topic.