Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-11T12:00:31.990Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-term outcome of patients who require renal replacement therapy after cardiac surgery

Published online by Cambridge University Press:  23 December 2005

G. Landoni ,
A. Zangrillo ,
A. Franco ,
G. Aletti ,
A. Roberti ,
M. G. Calabrò ,
G. Slaviero ,
E. Bignami  and
G. Marino
G. Landoni
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
A. Zangrillo
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
A. Franco
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
G. Aletti
Affiliation:
Università degli Studi di Milano, Department of Mathematics, Milano, Italy
A. Roberti
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
M. G. Calabrò
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
G. Slaviero
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Nephrology, Milano, Italy
E. Bignami
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
G. Marino
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
Get access

Extract

Summary

Background and objective: Acute renal failure is a serious complication of cardiac surgery. We studied the long-term survival and quality of life of patients requiring renal replacement therapy after cardiac surgery, since they represent a heavy burden on hospital resources and their outcome has never been adequately evaluated. Methods: Out of 7846 consecutive cardiac surgical patients, 126 (1.6%) required postoperative renal replacement therapy: their preoperative status and hospital course was compared with patients who had no need of postoperative renal replacement therapy. A multivariate analysis identified predictors of renal replacement therapy. Long-term survival and quality of life was collected in patients who had renal replacement therapy and in case-matched controls. Results: Hospital mortality in the study group was 84/126 (66.7%) vs. 118/7720 (1.5%) in the control population (P < 0.001). Patients who underwent renal replacement therapy and were discharged from the hospital (42 patients) had a reasonable long-term outcome: at 42 ± 23 months, 30 out of 42 patients were alive, with only 3 patients complaining of limitations in daily activities. Predictors of in-hospital renal replacement therapy were: emergency surgery, preoperative renal impairment, intra-aortic balloon pumping, reoperation for bleeding, previous cardiac surgery, female gender, low ejection fraction, bleeding >1000 mL, chronic obstructive pulmonary disease and age. Conclusions: This study confirms that the in-hospital mortality of patients requiring renal replacement therapy is high and shows a low long-term mortality with reasonable quality of life in patients discharged from hospital alive.

Keywords

KIDNEY FAILURE ACUTERENAL REPLACEMENT THERAPYCARDIAC SURGICAL PROCEDURESMORTALITYHOSPITAL MORTALITY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 1 , January 2006 , pp. 17 - 22
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998; 104: 343–348.Google Scholar
Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization – risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 1998; 128: 194–203.Google Scholar
Yeboa ED, Petrie A, Pead JL. Acute renal failure and open heart surgery. BMJ 1972; 1: 415–418.Google Scholar
Abel RM, Wick J, Beck CH et al. Renal dysfunction following open-heart operations. Arch Surg 1974; 108: 175–177.Google Scholar
Abel RM, Buckley MJ, Austen WG, Barnett GO, Beck Jr CH, 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 1976; 71: 323–333.Google Scholar
Bhat JC, Gluck MC, Lowenstein J, Baldwin DS. Renal failure after open heart surgery. Ann Intern Med 1976; 84: 677–682.Google Scholar
Mcleish KR, Loft FC, Kleit SA. Factors affecting prognosis in acute renal failure following cardiac operations. Surg Gynecol Obstet 1977; 145: 28–32.Google Scholar
Durmaz I, Buket S, Atay Y, Yagdi T, Ozbaran M, Boga M, Alat I, Guzelant A, Basarir S. Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure. J Thorac Cardiovasc Surg 1999; 118: 306–315.Google Scholar
Rao V, Weisel RD, Buth KJ et al. Coronary artery bypass grafting in patients with non-dialysis-dependent renal insufficiency. Circulation 1997; 96: II-38–II-45.Google Scholar
Corwin HL, Sprague SM, DeLaria GA, Norusis MJ. Acute renal failure associated with cardiac operations. J Thorac Cardiovasc Surg 1989; 98: 1107–1112.Google Scholar
Hiberman M, Derby GC, Spencer RJ, Stinson EB. Sequential pathophysiological changes characterizing the progression from renal dysfunction to acute failure following cardiac operation. J Thorac Cardiovasc Surg 1980; 79: 838–844.Google Scholar
Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993; 55: 552–559.Google Scholar
Hickey PR, Buckley MJ, Philbin DM. Pulsatile and nonpulsatile cardiopulmonary bypass: review of a counterproductive controversy. Ann Thorac Surg 1983; 36: 720–737.Google Scholar
Regragui IA, Izzat MB, Birdi I, Lapsley M, Bryan AJ, Angelini GD. Cardiopulmonary bypass perfusion temperature does not influence perioperative renal function. Ann Thorac Surg 1995; 60: 160–164.Google Scholar
Stewart AL, Hays RD, Ware Jr JE. The MOS short-form general health survey.Reliability and validity in a patient population. Med Care 1988; 26: 724–735.Google Scholar
Chertow GM, Lazarus JM, Christiansen CL et al. Preoperative renal risk stratification. Circulation 1997; 95: 878–884.Google Scholar
Endre ZH. Post cardiac surgery acute renal failure in the 1990s. Aust NZ J Med 1995; 25: 278–279.Google Scholar
Frost L, Pedersen RS, Lund O, Hansen OK, Hansen HE. Prognosis and risk factors in acute, dialysis-requiring renal failure after open-heart surgery. Scand J Thorac Cardiovasc Surg 1991; 25: 161–166.Google Scholar
Demirkiliç U, Kuralay E, Yenicesu M et al. Timing of replacement therapy for acute renal failure after cardiac surgery. J Card Surg 2004; 19: 17–20.Google Scholar
Alarabi A, Nystrom SO, Stahle E, Wikstrom B. Acute renal failure and outcome of continuous arteriovenous hemodialysis (CAVHD) and continuous hemofiltration (CAVH) in elderly patients following cardiovascular surgery. Geriatr Nephrol Urol 1997; 7: 45–49.Google Scholar
Baudouin SV, Wiggins J, Keogh BF, Morgan CJ, Evans TW. Continuous veno-venous haemofiltration following cardiopulmonary bypass. Intens Care Med 1993; 19: 290–293.Google Scholar
Bent P, Tan HK, Bellomo R et al. Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. Ann Thorac Surg 2001; 71: 832–837.Google Scholar
Levy B, Clavey M, Burtin P, Dopff CC, Hubert T, Villemot JP. Continuous venovenous hemofiltration after cardiac surgery. A retrospective study in 16 patients with multi organ failure. Annales Françaises d'Anesthésie et de Réanimation 1992; 11: 436–441.Google Scholar
Tsang GMK, Khan I, Dar M, Clayton D, Waller D, Patel RL. Hemofiltration in a cardiac intensive care unit – time for a rational approach. ASAIO J 1996; 42: M710–M713.Google Scholar
Leacche M, Rawn JD, Mihaljevic T et al. Outcomes in patients with normal serum creatinine and with artificial renal support for acute renal failure developing after coronary artery bypass grafting. Am J Cardiol 2004; 93: 353–356.Google Scholar
Utley JR. Cardiopulmonary bypass surgery. Curr Opin Cardiol 1992; 7: 267–275.Google Scholar