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The Effect of Acute Kidney Injury and Discharge Creatinine Level on Mortality Following Cardiac Surgery*

Engoren, Milo MD; Habib, Robert H. PhD; Arslanian-Engoren, Cynthia PhD; Kheterpal, Sachin MD; Schwann, Thomas A. MD

doi: 10.1097/CCM.0000000000000409
Clinical Investigations

Objectives: Acute kidney injury after cardiac surgery is associated with increased operative and late mortality. The objective was to determine if short and long term mortality are systematically improved with completeness of postoperative acute kidney injury reversal or with amount of residual renal function.

Design: Retrospective, single center study.

Setting: Tertiary care hospital.

Patients: One thousand five hundred and forty-three cardiac surgery patients divided into acute kidney injury groups based on Kidney Disease International Group Outcome criteria.

Measurements and Main Results: Operative mortality was 3.1% overall and was progressively worse with increasing acute kidney injury: none (0.8%), minimal (1.6%), Kidney Disease International Group Outcome stage 1 (4.3%), stage 2 (17%), and stage 3 (29%). Similar to the operative outcomes, late outcomes were progressively worse with rising amounts of acute kidney injury. The risk of late death was related to amount of acute kidney injury and remaining renal function at discharge.

Conclusions: Acute kidney injury was associated with higher operative and late mortality. Lesser amounts of residual renal function were associated with increased late mortality.

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1Department of Anesthesiology, University of Michigan, Ann Arbor, MI.

2Department of Internal Medicine and Outcomes Research Unit, American University of Beirut, Beirut, Lebanon.

3School of Nursing, University of Michigan, Ann Arbor, MI.

4Department of Surgery, University of Toledo, Toledo, OH.

* See also p. 2142.

This work was performed at the Department of Anesthesiology at Mercy St. Vincent Medical Center, Toledo, OH and the University of Michigan, Ann Arbor, MI.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Supported, in part, by departmental and institutional resources.

Dr. Engoren’s institution received grant support from the Douglass Foundation (to pay direct costs for a laryngoscopy study). Dr. Arslanian-Engoren is employed by the University of Michigan School of Nursing. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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