[Effects of open-heart surgery on renal function in patients with chronic renal failure--is hemodialysis during cardiopulmonary bypass really required?].
In 300 consecutive adult patients who underwent open-heart surgery in our department, 16 patients (ischemic heart disease in 8 patients, valvular heart disease in 7 and congenital heart disease in 1) were preoperatively complicated with chronic renal failure (CRF); creatinine clearance (Ccr) < 40 ml/min and serum creatinine (Scr) > 1.6 mg/dl. The effects of open-heart surgery on renal function were studied in these CRF patients who were divided into the following 3 groups according to their preoperative Ccr values: Group 1 (6 patients), 30 < Ccr < 40 ml/min; Group 2 (5 patients), 20 < Ccr < 30 ml/min; and Group 3 (5 patients, 4 of whom were on dialysis preoperatively), Ccr < 10 ml/min. In addition, Group C (38 patients, Ccr > 50 ml/min) was set up as normal controls. Instead of hemodialysis, the extracorporeal ultrafiltration method (ECUM) was employed for all patients during the cardiopulmonary bypass (CPB). The Ccr in Group 1 showed the lowest value of 24.2 +/- 12.0 ml/min on postoperative day (POD) 0 which then recovered to the preoperative level on POD 1. This quick recovery of the Ccr in Group 1 was similar to that in Group C. In contrast, the Ccr in Group 2 showed the lowest value of 13.0 +/- 6.0 ml/min on POD 1, followed by a delayed recovery that did not reach the preoperative level until POD 5. The Ccr in Group 3 was quite low (< 5 ml/min) throughout the test period.(ABSTRACT TRUNCATED AT 250 WORDS)
Mayumi
H
H
Department of Cardiovascular Surgery, Matsuyama Red Cross Hospital, Japan.
Uchida
T
T
Fukae
K
K
Umesue
M
M
Kohno
H
H
Shinozaki
K
K
Matsui
K
K
D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014462:Ultrafiltration