Cardiac surgery in patients with end-stage renal disease. Utility of continuous ambulatory peritoneal dialysis.
OBJECTIVE
The number of patients with end-stage renal disease undergoing open heart surgery continues to grow. We evaluated continuous ambulatory peritoneal dialysis and the extracorporeal ultrafiltration method during cardiopulmonary bypass in the management of these difficult patients.


METHODS
These 2 methods were used in 4 patients with renal failure who underwent open heart surgery between July 1997 and March 1999. Preoperative continuous ambulatory peritoneal dialysis was conducted using standard protocols. Extracorporeal ultrafiltration method was used only during cardiopulmonary bypass. Continuous ambulatory peritoneal dialysis was initiated upon arrival at the intensive care unit. Mean follow-up was 12 months.


RESULTS
Postoperative blood urea nitrogen and creatinine concentrations were lower than preoperative concentrations. No patients required hemodialysis. All 4 patients were discharged to their homes. No deaths occurred.


CONCLUSIONS
Continuous ambulatory peritoneal dialysis and extracorporeal ultrafiltration method are combined to treat patients with end-stage renal disease who require open heart surgery. This combination is simple, and does not require specialized personnel, and obviates the hemodynamic instability associated with hemodialysis.
Hamada
Y
Y
Department of Surgery II, Ehime University School of Medicine, Shitsukawa, Shigenobu, Ehime 791-0295, Japan.
Kawachi
K
K
Nakata
T
T
Takano
S
S
Tsunooka
N
N
Sato
M
M
Watanabe
Y
Y
Nakano
N
N
Miyauchi
K
K
Kohtani
T
T
D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006440:Hemofiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000706:statistics & numerical data*; D018487:Ventricular Dysfunction, Left / Q000601:surgery