Original article
Cardiovascular
Different Profiles of Patients Who Require Dialysis After Cardiac Surgery

https://doi.org/10.1016/j.athoracsur.2004.08.019Get rights and content

Background

This study was aimed at evaluating the determinants of postoperative dialysis-requiring acute renal failure and at identifying eventual correlations between the different etiologic mechanisms and postoperative prognosis.

Methods

We evaluated the preoperative and intraoperative features of the 69 out of 6,542 consecutive cardiac surgery patients who developed postoperative dialysis-requiring acute renal failure at our Institution during a 10-year period.

Results

Age, valvular and aortic surgery, hypertension, extracardiac vasculopathy, timing of surgery, cardiopulmonary bypass time, and preoperative creatinine level greater than 2.0 mg/dL were identified as predictors by multivariate analysis. In a second analysis, patients were divided in two groups according to the preoperative creatinine level: group A (preoperative creatinine 2.0 mg/dL or less; 38 cases) and group B (preoperative creatinine 2.1 mg/dL or more; 31 cases). The two groups significantly differed in preoperative and intraoperative characteristics and in postoperative outcome: group A patients were younger, had a lower incidence of cardiac and vascular risk factors and comorbidities, were mainly operated on urgent or emergent basis for valvular or aortic pathologies, had longer cardiopulmonary bypass and cross-clamp time, and worse in-hospital outcome but higher midterm survival. Group B patients were older, had a higher prevalence of comorbidities, required more often in-hospital or after-discharge dialysis, had lower in-hospital mortality, but reduced midterm survival.

Conclusions

Postoperative dialysis-requiring acute renal failure can be the result of two different pathophysiological pathways: complicated perioperative course due to urgent-emergent surgery or main intraoperative technical complications in patients with preoperative normal renal function and uncomplicated perioperative course associated with reduced preoperative kidney function. The two patient groups significantly differ in baseline preoperative features, as well as in in-hospital and in midterm outcome.

Section snippets

Patient Population

Patient population consisted of the 6,542 consecutive cases submitted to cardiac surgery procedures at our Institution from January 1992 to December 2002. Preoperative, intraoperative, and postoperative data of all patients were prospectively collected following the definitions in use at our Institution and reported in the Appendix; all data were then entered in a computerized database.

Acute renal failure was defined as a postoperative increase of the creatinine concentration greater than or

Predictors of DRARF

The characteristics of patients who developed DRARF compared to patients without this complication are listed in Table 1. Results of the univariate and multivariate analysis for the identification of predictors of DRARF are shown in Table 2, Table 3. Age, female sex, valvular and aortic surgery, hypertension, diabetes, extracardiac vasculopathy, timing of surgery, cardiopulmonary bypass and cross-clamp time, and preoperative creatinine level greater than 2.0 mg/dL were all predictors of DRARF

Comment

The occurrence of postoperative DRARF after a cardiac surgery procedure remains a dreaded event. In fact, it has been shown that this complication significantly increases in-hospital mortality and that even moderate degrees of renal dysfunction are associated with worse postoperative outcome 2, 4, 5, 6, 7. Moreover, survivors of postoperative renal injury have a twofold to threefold increase in the likelihood of discharge to an extended care facility compared to patients who do not experience

References (7)

There are more references available in the full text version of this article.

Cited by (50)

  • Moderate to Severe Acute Kidney Injury Leads to Worse Outcomes in Complex Thoracic Aortic Surgery

    2021, Annals of Thoracic Surgery
    Citation Excerpt :

    Despite having more patients with aortic arch interventions in the unadjusted AKI cohort, the use of HCA, as well as the complexity of arch reconstruction, was not found to be an independent risk factor for AKI. Although some previous studies found an association between AKI and the use of HCL, other more contemporary studies have found HCA to be safe from a renal perspective, even with the use of mild to moderate hypothermia if the HCA time is limited to less than 60 minutes.9-12 Our study further supports the safety of HCA in thoracic aortic surgery.

  • Adverse events and mitigation strategies

    2019, Mechanical Circulatory Support: A Companion to Braunwald’s Heart Disease
View all citing articles on Scopus
View full text