Risk factors for failure of continuous veno-venous hemodialysis in the treatment of acute renal failure following cardiac surgery

Abstract

Objective: To evaluate the risk factors for failure of continuous veno-venous hemodialysis (CVVHD) in the treatment of acute renal failure (ARF) after cardiac surgery.

Methods: Adult patients without any prior pre-operative history of chronic renal failure who underwent CVVHD after cardiac surgery in our medical center from January 2005 to December 2008 were divided into a success or a failure group. All selected patients’ pre-, intra-, and post-operative data were retrospectively analyzed. ARF was described as post-operative urinary output of less than 0.5ml/kg/h and/or a 50% increase in baseline BUN and serum creatinine levels.

Results: Fifty-two adult patients (accounting for 3.04%) who underwent CVVHD after cardiac surgery were entered into this study. Thirty-six patients survived, with a mortality rate of 30.8%. Pre-operative mean left ventricular ejection fraction (LVEF) in the success group was higher than that in the failure group (46±9% versus 40±7%, p=0.0220). Mean duration of oliguria until dialysis in the failure group was significantly longer than that in the success group (22.1±6.9h versus 11.6±2.5h, p<0.0001). Through univariate analysis and multivariate logistic regression, independent risk factors for failure of CVVHD in the treatment of post-operative ARF included pre-operative LVEF (OR=0.635, 95% CI 0.358-0.852) and duration of oliguria until dialysis (OR=2.442, 95% CI 1.563-5.768).

Conclusions: Pre-operative impaired left ventricular function is an important risk factor for failure of CVVHD in the treatment of ARF after cardiac surgery. The sooner CVVHD is instituted the better prognosis may be.

Keywords

hemodialysis acute renal failure cardiac surgery

Get full access to this article

View all access options for this article.

References

Bhat JG , Gluck MC , Lowenstein J. , Baldwin DS Renal failure after open heart surgery. Ann Intern Med 1976; 84: 677-682.

Bahar I. , Akgul A. , Ozatik MA , et al. Acute renal failure following open heart surgery: risk factors and prognosis. Perfusion 2005; 20: 317-322.

Pontes JC , Silva GV , Benfatti RA , Machado NP , Pontelli R. , Pontes ER Risk factors for the development of acute renal failure following on-pump coronary artery bypass grafting. Rev Bras Cir Cardiovasc 2007; 22: 484-490.

Elahi M. , Asopa S. , Pflueger A. , Hakim N. , Matata B. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg 2009; 35: 854-863.

Pannu N. , Klarenbach S. , Wiebe N. , Manns B. , Tonelli M. ; Alberta Kidney Disease Network. Renal replacement therapy in patients with acute renal failure: a systematic review. JAMA 2008; 299: 793-805.

Rukosujew A. , Klotz S. , Welp H. , et al. Surgery of secondary mitral insufficiency in patients with impaired left ventricular function. J Cardiothorac Surg 2009; 4: 36.

Seabra VF , Balk EM , Liangos O. , Sosa MA , Cendoroglo M. , Jaber BL Timing of renal replacement therapy initiation in acute renal failure: a meta-analysis . Am J Kidney Dis 2008; 52: 272-284.

Shore S. , Nelson DP , Pearl JM , et al. Usefulness of corticosteroid therapy in decreasing epinephrine requirements in critically ill infants with congenital heart disease. Am J Cardiol 2001; 88: 591-594.

Filsoufi F. , Rahmanian PB , Castillo JG , Mechanick JI , Sharma SK , Adams DH Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2007; 6: 753-758.

10.

Antunes PE , Prieto D. , Ferrão de Oliveira J. , Antunes MJ Renal dysfunction after myocardial revascularization. Eur J Cardiothorac Surg 2004; 25: 597-604.

11.

Ji Q. , Mei Y. , Wang X. , et al. Study on the risk factors of post-operative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J 2008; 72: 1975-1980.

12.

Manché A. , Casha A. , Rychter J. , Farrugia E. , Debono M. Early dialysis in acute kidney injury after cardiac surgery. Interact Cardiovasc Thorac Surg 2008; 7: 829-832.

13.

Nicoara A. , Patel UD , Phillips-Bute BG , et al. Mortality trends associated with acute renal failure requiring dialysis after CABG surgery in the United States. Blood Purif 2009; 28: 359-363.

14.

Iyem H. , Tavli M. , Akcicek F. , Büket S. Importance of early dialysis for acute renal failure after an open-heart surgery . Hemodial Int 2009; 13: 55-61.

15.

Lugones F. , Chiotti G. , Carrier M. , et al. Continuous renal replacement therapy after cardiac surgery. Review of 85 cases. Blood Purif 2004; 22: 249-255.

16.

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.

17.

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.

18.

Elahi MM , Lim MY , Joseph RN , Dhannapuneni RR , Spyt TJ Early hemofiltration improves survival in postcardiotomy patients with acute renal failure. Eur J Cardiothorac Surg 2004 ; 26: 1027-1031.