The incidence and risk of acute renal failure after cardiac surgery.
OBJECTIVE
To evaluate outcome and risk factors of acute renal failure in a surgical population with or without preoperative renal dysfunction.


METHODS
Observational study.


METHODS
Intensive care unit at a University Hospital.


METHODS
Five thousand sixty-eight consecutive adult patients who underwent cardiac surgery with cardiopulmonary bypass.


METHODS
Perioperative variables measured were age, sex, basic pathology, preoperative renal impairment defined as creatinine >1.4 mg/dL, ventricular dysfunction, preoperative neurologic event, chronic obstructive pulmonary disease, diabetes, type of surgery, use of intra-aortic balloon pump (IABP), cardiopulmonary bypass (CPB) duration, redo or emergency surgery, hemorrhage, blood transfusion, surgical revisions, and postoperative complications.


RESULTS
Acute renal failure (100% creatinine increase) developed in 171 (3.4%) patients, whereas 94 patients (1.9% of the population) had renal replacement therapy. Hospital mortality was 40.9% in patients with acute renal failure and increased to 63.8% when renal replacement therapy was requested. Sex, age, emergency surgery, low ejection fraction, IABP device, redo, diabetes, mitral valve surgery, CPB duration, and preoperative renal disease were independently associated with acute renal failure at a multivariate analysis.


CONCLUSIONS
This study confirms that acute renal failure is one of the major complications of cardiac surgery, identifies the risk factors, and suggests that optimizing cardiac output and reducing CPB time could improve the outcome of patients at high risk of acute renal failure.
Bove
Tiziana
T
Department of Cardiovascular Anesthesia, Vita-Salute University-IRCCS San Raffaele Hospital, via Olgettina (degree)60 20132 Milano, Italy. bove.tiziana@hsr.it
Calabrò
Maria Grazia
MG
Landoni
Giovanni
G
Aletti
Giacomo
G
Marino
Giovanni
G
Crescenzi
Giuseppe
G
Rosica
Concetta
C
Zangrillo
Alberto
A
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D003404:Creatinine