title: Intraoperative continuous venovenous hemofiltration during coronary surgery.
abstract: Postoperative continuous venovenous hemofiltration decreases acute renal failure in patients with moderate renal dysfunction undergoing coronary artery bypass grafting, but it prolongs intensive care unit stay. We developed a simple method to connect a hemofiltration machine to the cardiopulmonary bypass system. To evaluate the benefit of intraoperative hemofiltration, 124 consecutive patients (mean age, 67 +/- 6 years) with moderate renal dysfunction were studied. Surgery was preformed between January 2005 and May 2007. On-pump coronary artery bypass with hemofiltration was carried out in 40 patients (group A), 44 had on-pump coronary artery bypass without hemofiltration (group B), and 40 had off-pump coronary artery bypass (group C). Postoperative acute renal failure was defined as either renal failure requiring dialysis or >or=50% decline from the baseline glomerular filtration rate but not requiring dialysis. The 3 groups had similar demographic data and preoperative renal function. After adjusting for covariates and propensity scores, multivariate analysis showed that intraoperative hemofiltration and off-pump surgery protected postoperative renal function. Independent risk factors for postoperative renal dysfunction were age >70 years, left ventricular ejection fraction <35%, and the preoperative glomerular filtration rate.
authors.affiliation: Division of Cardiac Surgery, University of Rome, La Sapienza, Rome, Italy. aroscitano@katamail.com
authors.forename: Antonino
authors.initials: A
authors.lastname: Roscitano
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.forename: Massimo
authors.initials: M
authors.lastname: Goracci
authors.forename: Fabio
authors.initials: F
authors.lastname: Capuano
authors.forename: Remo
authors.initials: R
authors.lastname: Lucani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sinatra
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006440:Hemofiltration / Q000295:instrumentation; D006801:Humans; D007430:Intraoperative Care; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications