Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery.
BACKGROUND
Preoperative creatinine values higher than 2.5 mg/dL are associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery. We aimed to determine the effects of prophylactic perioperative hemodialysis on operative outcome in patients with nondialysis-dependent moderate renal dysfunction.


METHODS
Forty-four adult patients with creatinine levels greater than 2.5 mg/dL but not requiring dialysis underwent coronary artery bypass surgery with cardiopulmonary bypass. The patients were randomly divided into two groups. In group 1 (dialysis group, 21 patients), perioperative prophylactic hemodialysis was performed in all patients. Group 2 (23 patients) was taken as a control group and hemodialysis was performed only if postoperative acute renal failure was diagnosed.


RESULTS
The hospital mortality was 4.8% (1 patient) in the dialysis group, and 30.4% (7 patients) in the control group (p = 0.048). Postoperative acute renal failure requiring hemodialysis was seen in 1 patient (4.8%) in the dialysis group and in 8 patients (34.8%) in the control group (p = 0.023). Thirty-three postoperative complications were observed in the control group for an early morbidity of 52.2% (12 patients) and 13 complications occurred in 8 patients in the dialysis group (38.1%). The average length of the intensive care unit and postoperative hospital stay were shorter in the dialysis group than in the control group (p = 0.005 and p = 0.023, respectively).


CONCLUSIONS
Preoperative creatinine levels higher than 2.5 mg/dL, increase the risk of mortality and the development of acute renal failure and prolong the length of hospital stay after on-pump coronary artery bypass surgery. Perioperative prophylactic hemodialysis decreases both operative mortality and morbidity in these high-risk patients.
Durmaz
Isa
I
Department of Cardiovascular Surgery, Ege University Medical Faculty, Bornova, Izmir, Turkey.
Yagdi
Tahir
T
Calkavur
Tanzer
T
Mahmudov
Resad
R
Apaydin
Anil Z
AZ
Posacioglu
Hakan
H
Atay
Yüksel
Y
Engin
Cagatay
C
D058186:Acute Kidney Injury / Q000401:mortality / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011300:Preoperative Care; D006435:Renal Dialysis; D012306:Risk
D003404:Creatinine