title: Acute renal failure after cardiac surgery for carcinoid heart disease: incidence, risk factors, and prognosis.
abstract: BACKGROUND
  Cardiac surgery for carcinoid heart disease may be associated with acute renal failure (ARF) and multiorgan dysfunction postoperatively. This study was performed to determine the incidence, risk factors, and prognosis of ARF after cardiac surgery for carcinoid heart disease.
  
  
  METHODS
  This is a case-control study of 86 consecutive patients who underwent cardiac surgery for carcinoid heart disease. ARF is defined as hemodialysis requirement or serum creatinine level 50% greater than baseline, resulting in an estimated creatinine clearance less than 40 mL/min (0.67 mL/s). Preoperative, operative, and postoperative characteristics were examined and compared between groups to determine risk factors and prognosis of ARF.
  
  
  RESULTS
  ARF occurred in 22% of cases (19 of 86 patients). Preoperative characteristics and type of procedure did not differ between groups. Operative variables associated with ARF by means of univariate analysis included longer surgical and bypass times, intra-aortic balloon pump use, and perioperative epinephrine requirement. Postoperatively, ARF was associated with epinephrine use, prolonged mechanical ventilation, prolonged intensive care unit admission, and higher Acute Physiology and Chronic Health Evaluation II scores. Perioperative mortality in the ARF group was 47% versus 4.5% in the control group (odds ratio, 36.1; 95% confidence interval, 8.0 to 261.8).
  
  
  CONCLUSIONS
  ARF developed in a relatively high proportion of this cohort, but traditional preoperative risks failed to predict post-cardiac surgery ARF. Variables closely related to perioperative hemodynamic compromise were associated with ARF. ARF portends a particularly poor prognosis in this cohort that is explained largely by multiorgan failure syndrome.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. regner.kevin@mayo.edu
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Regner
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Robert C
authors.initials: RC
authors.lastname: Albright
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D000368:Aged; D002275:Carcinoid Heart Disease / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000401:mortality; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000601:surgery