From January 2000 to May 2011, 229 consecutive patients who did not require preoperative hemodialysis were retrospectively studied after elective TAR. Patients were grouped into the following categories: those with normal renal function (eGFR >90 mL/min/1.73 m2; n聽=聽11) and those with mild (eGFR, 60-90 mL/min/1.73 m2; n聽=聽86), moderate (eGFR, 30-59 mL/min/1.73 m2; n聽=聽111), or severe (eGFR <30 mL/min/1.73 m2; n聽=聽21) renal dysfunction. Linear trend tests demonstrated that the lower categories of eGFR were associated with a higher age, hypertension, coronary artery disease, peripheral arterial disease, and a higher EuroSCORE II.
The overall hospital mortality was 2.2%. A lower categories of eGFR were an independent risk factor for hospital mortality (odds ratio, 0.91; P聽=聽.002) and postoperative renal replacement therapy (odds ratio, 0.94; P聽<聽.002). A cutoff value for the requirement of postoperative renal replacement therapy was 26.0 mL/min/1.73 m2. Patients in the lower categories of eGFR had significantly higher hospital mortality (P聽=聽.03) and more morbidities, such as renal replacement therapy (P聽<聽.01), postoperative permanent neurologic deficits (P聽=聽.013), and prolonged mechanical ventilatory support (P聽<聽.01). Midterm survival and freedom from major adverse cerebrocardiovascular events were worse across the levels of the lower categories of eGFR.
Preoperative eGFR is a strong predictor of short- and midterm outcomes in contemporary TAR.