Acute renal failure following cardiac surgery

Acute renal failure following cardiac surgery,Peter J. Conlon,William D. White,Mark F. Newman,Sally King,Michelle P. Winn,Kevin Landolfo

Acute renal failure following cardiac surgery   (Citations: 88)
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went valve surgery, none of these variables were signi- ficantly associated with the development of ARF or Background. Acute renal failure requiring dialysis (ARF-D) occurs in 1-5% of patients following cardiac ARF-D in this group of patients. Conclusion. The development of ARF or ARF-D is surgery, and remains a cause of major morbidity and mortality. While some preoperative risk factors have associated with a high mortality following CABG surgery. We have identified perioperative variables, been characterized, the influence of preoperative and intraoperative factors on the occurrence of ARF fol- which may be useful in stratifying risk for the develop- ment of ARF. lowing cardiac surgery is less well understood. Methods. Preoperative and intraoperative data on Key words: cardiac surgery; haemodialysis; renal failure 2843 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) from February 1, 1995 to February 1, 1997 were recorded and entered into a computerized database. Two defini- Introduction tions of renal failure were employed: (i) ARF defined as a rise in serum creatinine (Cr) of 1 mg/dl above Acute renal failure (ARF ) remains a frequent and baseline; and (ii) ARF-D defined as the development serious complication of cardiac surgery. The incidence of ARF for which some form of dialytic therapy was of ARF following cardiac surgery has been reported required. The association between preoperative and to vary between 1 and 30% (1-6 ). When renal failure intraoperative variables and the development of ARF develops following cardiac surgery and is severe and was assessed by multivariate logistic regression. associated with the need for haemodialysis support, it Results. A total of 2672 of the 2844 patients underwent is associated with increased mortality, hospital stay isolated coronary artery bypass grafting (CABG) sur- and cost. Despite steady improvements in the results gery, the remaining 172 underwent valve surgery with of cardiac surgery, there has been a trend in operating or without bypass grafting. Of the CABG patients on higher risk patients, which inevitably leads to 7.9% developed ARF and 0.7% developed ARF-D. increased morbidity and mortality. The aetiology of The mortality for patients who developed ARF was renal insuYciency following cardiac surgery is poorly 14% (OR 15, P=0.0001) compared with 1% among understood, but it is believed that ischaemic injury of those who did not develop ARF. The mortality for the kidney, resulting from inadequate perfusion, is a CABG patients who developed ARF-D was 28% (OR major factor, although renal injury by exotoxins (e.g. 20, P=0.0001) compared with 1.8% among those who antibiotics, anaesthetic agents, contrast media, diur- did not require dialysis. Variables that were signific- etics) and endotoxins (e.g. myoglobin) may also be antly associated with the development of ARF by involved (7). multivariate analysis included: increased age, elevated This study was undertaken to evaluate the preval- preoperative serum Cr, duration of CPB, presence of ence, in-hospital mortality rate and the main risk a carotid artery bruit, presence of diabetes, reduced factors for the development of ARF. In an eVort to cardiac ejection fraction and increased body weight. address this issue, we prospectively studied a cohort Variables independently associated with ARF-D of 2844 patients who underwent cardiac surgery at our included serum Cr, duration of CPB, carotid artery institution over the last 2 years. bruit and presence of diabetes. The utility of these models for predicting the development of ARF and ARF-D was confirmed by bootstrapping techniques. Patients and methods Because of the small number of patients who under-
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