Safety of perioperative hemodialysis and continuous hemodiafiltration for dialysis patients with cardiac surgery.
OBJECTIVE
We have routinely used postoperative continuous hemodiafiltration (CHDF) combined with intraoperative hemodialysis (IHD) for dialysis patients undergoing open-heart surgery. This perioperative management could avoid any limitation of potassium concentration in the cardioplegic solution, strict restriction of fluid administration, or blood transfusion.


METHODS
To evaluate the safety of this strategy, 22 dialysis patients who underwent open-heart surgery (Dialysis Group) were retrospectively compared with 30 patients with normal renal function selected from the same time period with rigorously matched clinical characteristics such as age, gender, and operative procedures (Matched Group).


RESULTS
No significant difference was found in the operative variables such as the operative procedures, cardiopulmonary bypass time, and aortic cross-clamp time in both groups. There were two deaths (9.1%) in the Dialysis Group compared with Matched Group (0%). In the Dialysis Group, the levels of serum potassium and creatinine were well controlled in the perioperative period with a mean duration of IHD and CHDF of 243.7 +/- 60.6 min and 2.7 +/- 1.1 days, respectively. In particular, no significant difference between intraoperative and postoperative levels of serum potassium was observed in the Dialysis Group (P = 0.09), whereas there was a significant increase in the Matched Group (P = 0.004). Mean volume administered for the first 24 h after surgery was not different from the Matched Group. There were no vascular access-related complications in the Dialysis Group.


CONCLUSIONS
Postoperative CHDF combined with IHD can provide a similar management protocol for dialysis patients compared to patients with normal renal function.
Kamohara
Keiji
K
Department of Cardiovascular Surgery, Shin-Koga Hospital, 120 Tenjinn-cho, Kurume, Fukuoka, Japan.
Yoshikai
Masaru
M
Yunoki
Junji
J
Fumoto
Hideyuki
H
Murayama
Junichi
J
Hamada
Masakatsu
M
Itoh
Tsuyoshi
T
D000368:Aged; D000704:Analysis of Variance; D001806:Blood Urea Nitrogen; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D017583:Hemodiafiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D019990:Perioperative Care; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
D003404:Creatinine; D011188:Potassium