Hemodiafiltration during cardiac surgery in patients on chronic hemodialysis.
BACKGROUND
We have developed a hemodiafiltration (HDF) protocol used during cardiac surgery to preserve fluid and electrolyte balance and prevent postoperative bleeding in patients on chronic hemodialysis. This retrospective study examined the operative results associated with our new protocol.


METHODS
The study included 33 consecutive patients on long-term hemodialysis who underwent cardiac surgery at our hospital between January 2001 and April 2005, including off-pump coronary artery bypass grafting (CABG) in 19 patients. Vascular access was achieved via a 12-French double-lumen catheter inserted into the left femoral vein under general anesthesia, and HDF begun when the operation was started. After completion of cardiopulmonary bypass or, in patients who underwent off-pump CABG, after the distal anastomoses were completed, HDF was continued until target hematocrit between 30% and 35%, central venous pressure between 3 and 5 mmHg, and serum potassium concentration between 3.0 and 3.5 mEq/L were reached. The chest was closed after confirmation of hemostasis.


RESULTS
There was no in-hospital death. Three patients were extubated in the operating room. There were no postoperative wound infection, mediastinitis, respiratory tract infection, or hemorrhage. The patients were discharged at a mean of 15.6 days after operation.


CONCLUSIONS
These results suggest that intraoperative HDF lowers postoperative morbidity and mortality in chronic dialysis patients. Other advantages include early extubation and ambulation, and a shortened hospitalization.
Fukumoto
Atsushi
A
Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kaiji-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. fukumoto@koto.kpu-m.ac.jp
Yamagishi
Masaaki
M
Doi
Kiyoshi
K
Ogawa
Mitsugu
M
Inoue
Tomoya
T
Hashimoto
Satoru
S
Yaku
Hitoshi
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care; D007564:Japan; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D006435:Renal Dialysis; D012189:Retrospective Studies