Timing of replacement therapy for acute renal failure after cardiac surgery.
OBJECTIVE
Acute renal failure (ARF) following cardiac surgery remains a significant cause of mortality. The aim of this study is to compare early and intensive use of continuous veno-venous hemodiafiltration (CVVHDF) with conservative usage of CVVHDF in patients with ARF after cardiac surgery.


METHODS
Due to ARF, CVVHDF was required in two groups of a total of 61 adult patients (1.79% of all patients). Group 1 included 27 patients while Group 2 included 34 patients. CVVHDF was performed on Group 1 when creatinine level exceeded 5 mg/dL, or potassium level exceeded 5.5 mEq/L irrespective of the urine output. CVVHDF was performed on Group 2 when urine output was less than 100 mL within consecutive 8 hours, with no response to 50 mg furosemide with the supplementary criterion that urine sodium concentration should be >40 mEq/L before the administration of furosemide.


RESULTS
The mean elapsed time between the surgery and the initiation of CVVHDF was 2.56 +/- 1.67 days in Group 1 and 0.88 +/- 0.33 days in Group 2 (p = 0.0001). The mean intensive care unit (ICU) stay for Group 1 was 12 +/- 3.44 days and 7.85 +/- 1.26 days for Group 2 (p = 0.0001). ICU mortality rate was 48.1% for Group 1 and 17.6% for Group 2 (p = 0.014). The overall hospital mortality rate was 55.5% for Group 1 and 23.5% for Group 2 (p = 0.016).


CONCLUSIONS
Recognition of ARF and early beginning of the CVVHDF are extremely important. The sooner the ARF after surgery is recognized and CVVHDF is performed, the higher the likelihood of the reduction of the hospital mortality.
Demirkiliç
Ufuk
U
Cardiovascular Surgery Department, Etlik, Ankara, Turkey.
Kuralay
Erkan
E
Yenicesu
Müjdat
M
Cağlar
Kayser
K
Oz
Bilgehan Savaş
BS
Cingöz
Faruk
F
Günay
Celalettin
C
Yildirim
Vedat
V
Ceylan
Süleyman
S
Arslan
Mehmet
M
Vural
Abdulgaffar
A
Tatar
Harun
H
D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome