Long and short-term outcomes in patients requiring continuous renal replacement therapy post cardiopulmonary bypass

Luckraz, Heyman; Gravenor, Mike B; George, Ravi; Taylor, Sue; Williams, Andrew; Ashraf, Saeed; Argano, Vincenzo; Youhana, Aprim
May 2005
European Journal of Cardio-Thoracic Surgery;May2005, Vol. 27 Issue 5, p906
Academic Journal
Abstract: Objective: The development of acute renal failure following cardiac surgery is a rare but devastating complication with high morbidity and mortality. This study aimed to assess the incidence of acute renal failure necessitating continuous renal replacement therapy (CRRT) in patients who required cardiopulmonary bypass, to determine the factors associated with mortality and to evaluate long-term outcome. Methods: Patients who underwent cardiac surgery between October 1997 and 2003 and treated with CRRT were included (n=98). Six patients were then excluded (already in established renal failure pre-operatively) and one patient lost to follow-up. A retrospective analysis was carried out. Results: Overall CRRT was used in 2.9% (92/3172). The mean (SD) age of patients was 68 (10) years. Their mean pre-operative creatinine level and duration of cardiopulmonary bypass were 154 (87)micromol/l and 160 (84)min, respectively. Mean duration from surgery to establishment of CRRT was 50 (42)h. Mean creatinine level prior to hospital discharge was 168 (93)micromol/l. Thirty-day mortality was 42%. Significant risk factors for death were complex procedures (odds ratio=9.9), gastro-intestinal complications (OR=7.2), cross-clamp time over 88min (OR=5.9), re-exploration (OR=4.0) and patients age over 75 years (OR=3.3). Actuarial 1 and 5-year survivals (95% CI) were 53 (43, 63) % and 52 (42, 62) %, respectively. Only 2 (2.2%) patients required long term renal support. Conclusions: Acute renal failure necessitating the use of CRRT is a rare but serious complication post cardiopulmonary bypass. In the long-term, surviving patients are not likely to require further renal support.


Related Articles

  • The Stuck Central Venous Catheter: A Word of Caution Makhija, Neeti; Choudhury, Minati; Kiran, Usha; Chowdhury, Ujjwal // Heart, Lung & Circulation;Oct2008, Vol. 17 Issue 5, p432 

    The placement of central venous catheter (CVC) through internal jugular vein is not free from potential hazards. We report two cases of triple lumen central venous catheter, placed into right internal jugular vein, which got entrapped in patients who had undergone mitral valve replacement. The...

  • Monitoring the Electroencephalogram During Bypass Procedures. Gugino, Laverne D.; Aglio, Linda S.; Yli-Hankala, Arvi // Seminars in Cardiothoracic & Vascular Anesthesia;Jun2004, Vol. 8 Issue 2, p9 

    Electroencephalographic monitoring has been performed since the early days of cardiopulmonary bypass. Despite this long experience, the technology has never been widely used for cardiac operations. This review examines the reasons for the limited use and describes technological advances that may...

  • Levels of vasopressin in children undergoing cardiopulmonary bypass. Morrison, Wynne E.; Simone, Shari; Conway, Dyana; Tumulty, Jamie; Johnson, Cynthia; Cardarelli, Marcelo // Cardiology in the Young;Apr2008, Vol. 18 Issue 2, p135 

    Objectives: It is accepted treatment to give vasopressin to adults in postcardiotomy shock, but such use in children is controversial. Cardiopulmonary bypass is presumed to attenuate the normal endogenous vasopressin response to shock. We hypothesized that levels of vasopressin in children are...

  • Evaluation of Epsilon Amino-Caproic Acid (EACA) and Autologous Blood as Blood Conservation Strategies in Patients Undergoing Cardiac Surgery Sharma, Vishal; Talwar, Sachin; Choudhary, Shiv Kumar; Lakshmy, Rama; Kale, Shailaja; Kumar, Arkalgud Sampath // Heart, Lung & Circulation;Aug2006, Vol. 15 Issue 4, p261 

    Background: To evaluate the effects of autologous blood and Epsilon amino-caproic acid on intra-operative and post-operative blood loss and homologous blood product requirements in patients undergoing cardiac surgery. Methods: Patients were randomly allocated to two groups of 30 each. In the...

  • Cardiopulmonary Bypass to Facilitate Excision of a Giant Pleural Tumour Manners, James L.; Khan, Omar A.; Brown, Ivan; Amer, Khalid M. // Heart, Lung & Circulation;Feb2008, Vol. 17 Issue 1, p76 

    A 55-year-old female developed dyspnoea following an elective hysteroscopy. A chest radiograph demonstrated a tissue density opacity occupying the right hemithorax. A CT scan suggested this was a tumour arising from the postero-lateral chest wall. Surgical resection was attempted; however,...

  • Peroxynitrite, a product between nitric oxide and superoxide anion, plays a cytotoxic role in the development of post-bypass systemic inflammatory response. Hayashi, Yoshitaka; Sawa, Yoshiki; Nishimura, Motonobu; Fukuyama, Naoto; Ichikawa, Hajime; Ohtake, Shigeaki; Nakazawa, Hiroe; Matsuda, Hikaru // European Journal of Cardio-Thoracic Surgery;Aug2004, Vol. 26 Issue 2, p276 

    Objective: Cardiopulmonary bypass (CPB) is known to induce post-bypass systemic inflammatory response. Peroxynitrite (ONOO-) is a potent oxidant formed by a rapid reaction between nitric oxide (NO) and superoxide anion. We hypothesized that ONOO- plays a role in the development of post-bypass...

  • Efficacy of FK633, an ultra-short acting glycoprotein IIb/IIIa antagonist on platelet preservation during and after cardiopulmonary bypass. Tabata, Shigeki; Yamaguchi, Syohjiro; Nagamine, Hiroshi; Tomita, Shigeyuki; Arai, Sadahiko; Takemura, Hirofumi; Watanabe, Go // European Journal of Cardio-Thoracic Surgery;Aug2004, Vol. 26 Issue 2, p289 

    Objective: Temporary pharmacologic inhibition of platelet function during and after cardiopulmonary bypass (CPB) (platelet anesthesia) is an attractive strategy for preserving platelets during CPB. We examined the efficacy of FK633, an ultra-short acting glycoprotein IIb/IIIa antagonist....

  • Does the off-pump Fontan procedure ameliorate the volume and duration of pleural and peritoneal effusions? Shikata, Fumiaki; Yagihara, Toshikatsu; Kagisaki, Koji; Hagino, Ikuo; Shiraishi, Shuichi; Kobayashi, Junjiro; Kitamura, Soichiro // European Journal of Cardio-Thoracic Surgery;Sep2008, Vol. 34 Issue 3, p570 

    Abstract: Objective: We initiated an off-pump Fontan procedure by using temporary bypass from the inferior vena cava to the atrium and advanced the procedure in selected patients by simply cross-clamping the inferior vena cava. We aimed to investigate whether the off-pump Fontan procedure could...

  • Evaluation of Cystatin C as a marker of renal injury following on-pump and off-pump coronary surgery. Abu-Omar, Yasir; Mussa, Shafi; Naik, Madhava J.; MacCarthy, Noel; Standing, Sue; Taggart, David P. // European Journal of Cardio-Thoracic Surgery;May2005, Vol. 27 Issue 5, p893 

    Abstract: Objective: Cardiopulmonary bypass is regarded as an important contributor to renal injury, whereas off-pump surgery is considered less damaging. Cystatin C, a cystine protease inhibitor, is more sensitive and specific than creatinine in the assessment of renal function. We assessed the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics