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Chirag R. Parikh, MD, PhD; Steven G. Coca, DO; Grace L. Smith, MD; Viola Vaccarino, MD, PhD; Harlan M. Krumholz, MD

Arch Intern Med. 2006;166:2014-2019.

Background  Little is known about the impact of chronic kidney disease (CKD) on health-related quality-of-life outcomes after coronary artery bypass grafting (CABG).

Methods  Our objective was to examine the changes in physical function (PF) and mental health (MH) 6 months after CABG in 1055 patients with and without CKD. The primary end points were mean change in score and status of "improved" or "worsened" in both PF and MH subscales of the Medical Outcomes Trust Short Form 36-Item Health Survey from baseline to 6 months after CABG, stratified by CKD stage (0-5).

Results  Absolute PF and MH scores at baseline and at 6 months varied by renal impairment level. Patients with severe CKD (stages 4-5) had a mean (SD) decrease in PF score at 6 months of 3 (3) compared with increases in the rest of the cohort (P<.001). After adjustment for baseline score, 21% of patients with advanced CKD experienced worsened PF scores, compared with 0% of patients with stages 0 to 2 and stage 3 CKD (P<.001). In contrast to PF scores, patients with and without CKD had similar improvements in mean MH scores at 6 months, and patients with stages 4 to 5 CKD had the highest frequency of those with improved MH scores (77%). After adjustment, no patients experienced worsened MH scores.

Conclusions  After 6 months, patients with severe CKD who underwent CABG had improvement in MH but not improvement in PF and may have had worsened PF compared with those without severe CKD. Comparable evidence regarding quality-of-life outcomes in the absence of CABG is needed to more fully inform decision making regarding patients with severe CKD and coronary artery disease.

Author Affiliations: Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, Conn (Drs Parikh and Coca); Departments of Medicine, Schools of Medicine, Yale University, New Haven, Conn (Drs Parikh, Coca, Smith, and Krumholz), and Emory University, Atlanta, Ga (Dr Vaccarino).

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