title: Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure.
abstract: OBJECTIVE
  Renal failure is known to increase the morbidity and mortality in patients undergoing cardiac surgery. The results of heart surgery in patients with non-dialysis-dependent, mild renal insufficiency are not clear.
  
  
  METHODS
  One hundred nineteen adult patients with chronic renal failure underwent cardiac surgery. Group I consisted of 93 patients who had creatinine levels between 1.6 and 2.5 mg/dL but who were not supported by dialysis. Group II consisted of 18 patients with creatinine levels higher than 2.5 mg/dL who were not supported by dialysis. Group III consisted of 8 patients with end-stage renal disease who were receiving hemodialysis.
  
  
  RESULTS
  The hospital mortality rates were 11.8%, 33.0%, and 12.5%, respectively. Morbidity was 21.5%, 44.4%, and 75.0%, respectively, in groups I, II, and III. Postoperative hemodialysis was needed in 2 (2.15%) patients from group I and 6 (33%) patients from group II. On multivariable logistic regression analysis, risk factors for mortality were preoperative creatinine level more than 2.5 mg/dL, angina class III-IV, emergency operation, excessive mediastinal hemorrhage, postoperative pulmonary insufficiency, low cardiac output, and rhythm disturbances. Risk factors for morbidity were preoperative creatinine level more than 2.5 mg/dL and postoperative dialysis.
  
  
  CONCLUSIONS
  Chronic renal failure increases the mortality and morbidity in patients undergoing cardiac surgery. Renal insufficiency with creatinine levels higher than 2.5 mg/dL increases the risk of postoperative dialysis and prolongs the length of hospital stay. Careful preoperative management and intraoperative techniques, such as avoiding low perfusion pressure and using low-dose dopamine, may be useful for a good operative outcome.
authors.affiliation: Ege University Medical Faculty, Department of Cardiovascular Surgery, Izmir, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Durmaz
authors.forename: S
authors.initials: S
authors.lastname: Büket
authors.forename: Y
authors.initials: Y
authors.lastname: Atay
authors.forename: T
authors.initials: T
authors.lastname: Yağdi
authors.forename: M
authors.initials: M
authors.lastname: Ozbaran
authors.forename: M
authors.initials: M
authors.lastname: Boğa
authors.forename: I
authors.initials: I
authors.lastname: Alat
authors.forename: A
authors.initials: A
authors.lastname: Güzelant
authors.forename: S
authors.initials: S
authors.lastname: Başarir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000401:mortality; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003404:Creatinine