The effect of hemodilution during normothermic cardiac surgery on renal physiology and function: a review

Vermeer, H.; Teerenstra, S.; de Sévaux, R. G. L.; van Swieten, H. A.; Weerwind, P. W.
November 2008
Perfusion;Nov2008, Vol. 23 Issue 6, p329
Academic Journal
Although the definitions of renal dysfunction vary, loss of renal function is a common complication following cardiac surgery using cardiopulmonary bypass (CPB). When postoperative dialysis is required, mortality is approximately 50%. CPB-accompanied hemodilution is a major contributing factor to renal damage as it notably reduces oxygen delivery by reducing the oxygen transport capacity of the blood as well as disturbing the microcirculation. To minimize hypoxemic damage during CPB, lowering of body temperature is applied to reduce the patient's metabolic rate. At present, however, temperature management during elective adult cardiac surgery is shifting from moderate hypothermia to normothermia. To determine whether the currently accepted levels of hemodilution during CPB can suffice the normothermic patient's high oxygen demand, we focused this study on renal physiology and postoperative renal function. Hemodilution reduces the capillary density through a diminished capillary viscosity, thereby, redistributing blood from the renal medulla to the renal cortex. As the physiology of the renal medulla makes it a hypoxic environment, this part of the kidney appears to be especially at risk for hypoxic damage caused by a hemodilution-induced lowered oxygen transport and oxygen delivery. In addition, hemodilution is also likely to disturb the hormonal systems regulating renal blood distribution. Clinical studies, mostly of retrospective or observational nature, show that perioperative nadir hematocrit levels lower than approximately 24% are associated with an increased risk to develop postoperative renal failure. A better comprehension of the causeand- effect relation between low perioperative hematocrits and loss of postoperative renal function may enable more effective renal protective strategies.


Related Articles

  • Factors affecting postoperative blood loss in children undergoing cardiac surgery. Faraoni, David; Van der Linden, Philippe // Journal of Cardiothoracic Surgery;2014, Vol. 9 Issue 1, p1 

    We hypothesized that the influence of cyanotic disease on postoperative blood loss is closely related to age in children undergoing cardiac surgery. Here, we demonstrate that the presence of a cyanotic disease is associated with increased postoperative blood loss in children aged 1 to 6 months....

  • Cardiopulmonary bypass management and acute renal failure: risk factors and prognosis. Sirvinskas, E.; Andrejaitiene, J.; Raliene, L.; Nasvytis, L.; Karbonskiene, A.; Pilvinis, V.; Sakalauskas, J. // Perfusion;Nov2008, Vol. 23 Issue 6, p323 

    The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who...

  • Effects of protective and conventional mechanical ventilation on pulmonary function and systemic cytokine release after cardiopulmonary bypass. Koner, Ozge; Celebi, Serdar; Balci, Huriye; Cetin, Gurkan; Karaoglu, Kamil; Cakar, Nahit // Intensive Care Medicine;Apr2004, Vol. 30 Issue 4, p620 

    Objective: To evaluate the effects of protective and conventional ventilation with or without positive end-expiratory pressure (PEEP), on systemic tumor necrosis factor-alpha, interleukin-6 levels and pulmonary function during open heart surgery.Design: Prospective,...

  • Comparison of the effects of gelatin and a modern hydroxyethyl starch solution on renal function and inflammatory response in elderly cardiac surgery patients. J. Boldt; Ch. Brosch; K. Röhm; M. Papsdorf; A. Mengistu // BJA: The British Journal of Anaesthesia;Apr2008, Vol. 100 Issue 4, p457 

    Background The effects of hydroxyethylstarch (HES) 130/0.4 6% and gelatin 4% on inflammation, endothelial integrity, and renal function after cardiac surgery were compared. Methods Sixty patients aged >80 yr undergoing cardiac surgery were randomized to receive gelatin (n=30) or HES 130/0.4...

  • Comparison of S100B and NSE Between Cardiac Surgery and Interventional Therapy for Children. Yu Liu; Ying Xu; Da-zhen Li; Yuan Shi; Mao Ye // Pediatric Cardiology;Oct2009, Vol. 30 Issue 7, p893 

    This study aimed to compare the release of S100B and NSE between cardiac surgery and interventional therapy for children and to investigate whether S100B serum concentration correlates with cardiopulmonary bypass in children. For this study, 40 children with congenital heart disease were...

  • Retrospective Study Of Redo Cardiac Surgery In A Single Centre. Karthekeyan, Ranjith B.; Selvaraju M.D., Karthikeyan N.; Ramanathan, Lakshmi; Rakesh, M. G.; Rao, K. G. Suresh; Vakamudi, Mahesh; Balakrishnan, K. R. // Internet Journal of Anesthesiology;2007, Vol. 13 Issue 1, p29 

    Background: An increasing number of patients are being referred to tertiary referral centre for re-do cardiac surgery and will continue to increase. Though it is a sign of improving medical care and better management, it is a challenge for every cardiac anesthesiologist in handling this subset...

  • ULTRASONIC RADIATION FORCE FOR EMBOLI REMOVAL FROM BLOOD. Campbell, C. A.; Hinders, M. K. // AIP Conference Proceedings;2/22/2010, Vol. 1211 Issue 1, p1551 

    In this work we investigate the removal of emboli from cardiopulmonary bypass circuits via acoustic radiation force. Unless removed, emboli can be a significant source of cognitive deficit after cardiac surgery. We have implemented both inviscid linear and viscous non-linear models for radiation...

  • Treatment of accidental hypothermia with cardiopulmonary bypass: a case report. Binnema, R.; van der Wal, A.; Visser, C.; Schepp, R.; Jekel, L.; Schröder, P. // Perfusion;May2008, Vol. 23 Issue 3, p193 

    This case report describes the successful treatment of severe accidental hypothermia of a 40-year-old woman. At arrival in the operating theatre her rectal temperature was 23°C, her nasal temperature 21°C and her periferal temperature 14°C. The patient presented with a severe...

  • Does a reduced glucose intake prevent hyperglycemia in children early after cardiac surgery? a randomized controlled crossover study. I. de Betue, Carlijn T.; A.T. Verbruggen, Sascha C.; Schierbeek, Henk; Chacko, Shaji K.; J.C. Bogers, Ad J.; van Goudoever, Johannes B.; M. Joosten, Koen F. // Critical Care;2012, Vol. 16 Issue 5, p11658 

    Introduction: Hyperglycemia in children after cardiac surgery can be treated with intensive insulin therapy, but hypoglycemia is a potential serious side effect. The aim of this study was to investigate the effects of reducing glucose intake below standard intakes to prevent hyperglycemia, on...


Read the Article


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

Try another library?
Sign out of this library

Other Topics