%0 Journal Article
%T Preoperative Proteinuria Is Associated with Long-Term Progression to Chronic Dialysis and Mortality after Coronary Artery Bypass Grafting Surgery
%A Vin-Cent Wu
%A Tao-Min Huang
%A Pei-Chen Wu
%A Wei-Jie Wang
%A Chia-Ter Chao
%A Shao-Yu Yang
%A Chih-Chung Shiao
%A Fu-Chang Hu
%A Chun-Fu Lai
%A Yu-Feng Lin
%A Yin-Yi Han
%A Yih-Sharng Chen
%A Ron-Bin Hsu
%A Guang-Huar Young
%A Shoei-Shen Wang
%A Pi-Ru Tsai
%A Yung-Ming Chen
%A Ting-Ting Chao
%A Wen-Je Ko
%A Kwan-Dun Wu
%A the NSARF Group
%J PLOS ONE
%D 2012
%I Public Library of Science (PLoS)
%R 10.1371/journal.pone.0027687
%X Aims Preoperative proteinuria is associated with post-operative acute kidney injury (AKI), but whether it is also associated with increased long- term mortality and end -stage renal disease (ESRD) is unknown. Methods and Results We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+) or heavy (2+ to 4+) according to the results of the dipstick test. A total of 276 (29.8%) patients had mild proteinuria before surgery and 119 (12.9%) patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17) was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88) and heavy proteinuria ([HR], 2.28) to predict all¨Ccause mortality compared to no proteinuria. Mild ([HR], 2.57) and heavy proteinuria ([HR], 2.70) exhibited a stepwise increased ratio compared to patients without proteinuria for long¨Cterm composite catastrophic outcomes (mortality and ESRD), which were independent of the baseline GFR and postoperative acute kidney injury (AKI). Conclusion Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients.
%U http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0027687