Renal dysfunction after cardiac surgery with normothermic cardiopulmonary bypass: incidence, risk factors, and effect on clinical outcome.
Renal dysfunction is a frequent and severe complication after conventional hypothermic cardiac surgery. Little is known about this complication when cardiopulmonary bypass (CPB) is performed under normothermic conditions (e.g., more than 36 degrees C). Thus, we prospectively studied 649 consecutive patients undergoing coronary artery bypass surgery or valve surgery with normothermic CPB. The association between renal dysfunction (defined as a > or =30% preoperative-to-maximum postoperative increase in serum creatinine level) and perioperative variables was studied by univariate and multivariate analysis. Renal dysfunction occurred in 17% of the patients. Twenty-one (3.2%) patients required dialysis. Independent preoperative predictors of this complication were: advanced age, ASA class >3, active infective endocarditis, radiocontrast agent administration <48 h before surgery, and combined surgery. When all the variables were entered, active infective endocarditis, radiocontrast agent administration, postoperative low cardiac output, and postoperative bleeding were independently associated with renal dysfunction. The in-hospital mortality rate was 27.5% when this complication occurred (versus 1.6%; P < 0.0001). Furthermore, postoperative renal dysfunction was independently associated with in-hospital mortality (odds ratio, 4.1 [95% confidence interval, 1.3-12.8]). We conclude that advanced age, active endocarditis, and recent (within 48 h) radiocontrast agent administration, as well as postoperative hemodynamic dysfunction, are more consistently predictive of postoperative renal dysfunction than CPB factors.


CONCLUSIONS
We found that postoperative renal dysfunction was a frequent and severe complication after normothermic cardiac surgery, independently associated with poor outcome. Independent predictors of this complication were advanced age, active endocarditis, and recent (within 48 h) radiocontrast agent administration (the only preoperative modifiable factor), as well as postoperative hemodynamic dysfunction.
Provenchère
Sophie
S
*Département Anesthésie-Réanimation and †Service de Néphrologie, Hôpital Bichat-Claude Bernard; and ‡Laboratoire de Biophysique, Hôpital Fernand Widal, Paris, France.
Plantefève
Gaetan
G
Hufnagel
Gilles
G
Vicaut
Eric
E
de Vaumas
Cyrille
C
Lecharny
Jean-Baptiste
JB
Depoix
Jean-Pol
JP
Vrtovsnik
François
F
Desmonts
Jean-Marie
JM
Philip
Ivan
I
D000368:Aged; D000704:Analysis of Variance; D001831:Body Temperature / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D007677:Kidney Function Tests; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology