title: Renal dysfunction after thoracic aortic surgery requiring deep hypothermic circulatory arrest: definition, incidence, and clinical predictors.
abstract: OBJECTIVE
  The purpose of this study was to evaluate renal dysfunction (RD) after thoracic aortic surgery (TAS) requiring deep hypothermic circulatory arrest (DHCA), to determine the influence of definition on RD after TAS-DHCA, to determine univariate predictors of RD after TAS-DHCA, and to determine multivariate predictors for RD TAS-DHCA. RD was defined in 3 ways: (1) >25% reduction in creatinine clearance, (2) >50% increase in serum creatinine, and (3) >50% increase in serum creatinine with an abnormal peak serum creatinine (>1.3 mg/dL for men and >1.0 mg/dL for women).
  
  
  METHODS
  Retrospective and observational.
  
  
  METHODS
  Single large university hospital.
  
  
  METHODS
  All adults requiring TAS-DHCA in 2000 and 2001.
  
  
  RESULTS
  The cohort size was 144. Antifibrinolytic exposure was 100%: aprotinin 66% and aminocaproic acid 34%. The incidence of RD TAS-DHCA was 22.9% to 38.2%, depending on the definition. The incidence of renal replacement therapy was 2.8%. Multivariate predictors for RD after TAS-DHCA were sepsis, aprotinin exposure, preoperative hypertension, age, and donor exposures.
  
  
  CONCLUSIONS
  Although RD after TAS-DHCA varies substantially because of definition, it is still very common. Its multivariate predictors merit further focused research to enhance perioperative protection of the kidney.
authors.affiliation: Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. yiandoc@hotmail.com <yiandoc@hotmail.com>
authors.forename: John G T
authors.initials: JG
authors.lastname: Augoustides
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: E Andrew
authors.initials: EA
authors.lastname: Ochroch
authors.forename: Doreen
authors.initials: D
authors.lastname: Cowie
authors.forename: Justin
authors.initials: J
authors.lastname: Weiner
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gambone
authors.forename: Dawn
authors.initials: D
authors.lastname: Pinchasik
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: David R
authors.initials: DR
authors.lastname: Jobes
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome