Impact of occult renal disease on the outcomes of off-pump and on-pump coronary artery bypass grafting

  • Lokeswara Rao SajjaEmail author
  • Sudhanshu Singh
  • Gopichand Mannam
  • Jyothsna Guttikonda
  • Venkata Ramachandra Raju Pusapati
  • Krishnamurthy Venkata Satya Siva Saikiran
Original Article



Occult renal disease (ORD) is a clinical condition in which glomerular filtration rate (GFR) is less than 60 ml/min/1.73 m2, while serum creatinine is ≤ 1.3 mg/dl. The aim of the study was to compare the incidence of postoperative stage I acute kidney injury (AKI) according to Acute Kidney Injury Network (AKIN) classification in patients with ORD undergoing either off-pump or on-pump coronary artery bypass grafting.


A single center prospective randomized study was conducted from March 2011 through January 2014. A total of 120 coronary artery disease (CAD) patients with ORD undergoing coronary artery bypass grafting (CABG) were randomized to either off-pump (group1, n = 62) or on-pump (group2, n = 58) CABG in 1:1 ratio by computer-generated random number table. The GFR and serum creatinine levels were measured preoperatively and postoperatively on day 1 and day 5. The primary outcome (postoperative AKI (stage I)) and secondary outcomes (AKI (stage III) requiring renal replacement therapy (RRT) death, myocardial infarction (MI), cerebrovascular accident, atrial fibrillation (AF), and re-exploration for bleeding) at 30 days were analyzed between the groups.


There is no significant difference in baseline characteristics of patients between off-pump and on-pump group. The incidence of postoperative AKI (stage I) was similar between on-pump (20.69%) and off-pump (16.13%) groups (p = 0.51). There was no significant difference in mortality (p = 0.33), postoperative MI (p = 0.34), cerebrovascular accident (p = 1.00), re-exploration (p = 0.96), and AF (p = 0.50). The number of patients of stage III AKI requiring RRT was higher in the off-pump group (3 patients, 4.8%) and none in the on-pump group (p = 0.08),


This study demonstrated that on-pump CABG is associated with significantly lower GFR and significantly higher serum creatinine on postoperative day 1 which return to baseline by postoperative day 5. In patients with ORD undergoing CABG, the incidence of postoperative AKI and major adverse cardiac and cerebrovascular events were similar between off-pump or on-pump CABG patients.


ORD: Occult renal disease GFR: Glomerular filtration rate AKI: Acute kidney injury 



We thank Mr.A.Nadamuni Naidu, M.Sc (Stat), Head, Department of Statistics (Retired), National Institute of Nutrition, ICMR, Hyderabad, India, and Sajja Heart Foundation, Hyderabad, India, for statistical advice; and Prashanthi Beri M.Sc (Clinical Research), Clinical Research Associate, Sajja Heart Foundation, Hyderabad, India, for the help in preparing the manuscript and analysis for this study.

Compliance with ethical standards

This study complies with the principles of the Declaration of Helsinki and was approved by the institutional ethics committee, and informed consent was obtained from all the patients.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Lokeswara Rao Sajja
    • 1
    • 2
    Email author
  • Sudhanshu Singh
    • 1
  • Gopichand Mannam
    • 1
  • Jyothsna Guttikonda
    • 2
    • 3
  • Venkata Ramachandra Raju Pusapati
    • 2
    • 4
  • Krishnamurthy Venkata Satya Siva Saikiran
    • 1
  1. 1.Division of Cardiothoracic SurgeryStar HospitalsHyderabadIndia
  2. 2.Sajja Heart FoundationHyderabadIndia
  3. 3.Division of NephrologyStar HospitalsHyderabadIndia
  4. 4.Division of CardiologyStar HospitalsHyderabadIndia

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