ACUTE RENAL FAILURE AFTER CARDIOPULMONARY BYPASS SURGERY
AbstractBackground: Acute renal failure (urine output <0.5ml/kg/hr.) following cardiopulmonary bypass is an uncommon but highly lethal complication which arises in the setting of inadequate cardiac function and may be associated with multi-organ failure. Acute renal failure (ARF) after cardiopulmonary bypass occurs in about 8% of adult cardiac surgical patients with some preoperative renal impairment and in about 3-4% of patients with normal preoperative renal parameters. This study was conducted to determine the frequency of acute renal failure after cardiopulmonary bypass operations and to find possible risks factors. Methods: We analyzed the data of 500 consecutive patients who survived the first 24 hours after open heart surgery at Punjab Institute of Cardiology, Lahore as this is the minimum time to evaluate post-operative renal function, their morbidity, mortality and the main contributing risk factors, from July 2000 to Dec. 2000. The association between preoperative, intra-operative and postoperative variables and the development of ARF was assessed by multivariate logistic regression. Results: Of the 500 consecutive patients 35 (7%) patients developed acute renal failure (serum creatinine>2.5 mg/dl) and 102 (20.4%) patients developed acute renal dysfunction (serum creatinine 1.6-2.4 mg/dl). Positive risk factors noted in the development of ARF were age, raised preoperative blood urea and creatinine, diabetes mellitus, low cardiac output state, oligurea, total CPB time, total cross clamp time and significant hypotension during the procedure or during intensive care unit (ICU) stay. Mortality rate for established ARF was extremely poor (88.8 %) and there were only four (4) survivors among those requiring dialysis. Conclusions: Prevention of this disastrous complication appears to be better than treatment once it is fully established. However newer aggressive forms of early renal replacement / transplant therapies may have some promise.Key words: Acute Renal failure, CABG, Cardiopulmonary bypass surgery
Conlon PI, Stafford-Smith M, Whit WD, Newman M, King S, Wihn MP. Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999;14(5):115-9.
Jolm EG, Levitsky S, Hastreiter AR. Management of acute renal failure complicating cardiac surgery. Crit Care Med 1999; 8(10):562-9.
Abel RM, Buckley MJ, Austen WG, Barnett GO, Beck CHD, Fischer JE. Etiology, incidence and prognosis of renal failure following cardiac operations, results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg 1996; 71:323-3.
Chew ST, Newman MF, White WD, Conlon PJ, Saunders AM, Strittmatter WT, et al. Preliminary report on the association of apolipoprotein E polymorphisms, with postoperative peak creatinine concentrations in cardiac surgical patients. Anesthesiology 2000; 93(2):325-31.
Vanholder R, Lameire E, Hoste A, Van Loo, Dhondat AM, Ringoir S. Pathophysiology of acute renal failure. In: Choice of dialysis membranes for acute renal failure. International yearbook of nephrology 1996;12:107-116.
Giorgio Z, Michielon P, Paccagnella A, Rosi P, Calo M, Salander V et al. acute renal failure in the patients undergoing cardiac operation. J Thorac Cardiovasc Surg 1999;107(6):1489-95.
Slogoff S, Reul GJ, Keats AS. Role of perfusion pressures and flow in major organ dysfunction after cardiopulmonary bypass. Aml Thorac Surg 1990;50:911-8.
Suen WS, Mok CK, Chiu SW, Cheung KL, Lee WT, Cheung D. Risk factors for development of ARF requiring dialysis in patients undergoing cardiac surgery. Angiology 1998;49(10):789-800.