Nephrology Dialysis Transplantation, Vol 14, Issue 5 1158-1162, Copyright © 1999 by Oxford University Press
P Conlon, M Stafford-Smith, W White, M Newman, S King, M Winn and K Landolfo
Background. Acute renal failure requiring dialysis
(ARF-D) occurs in 1-5% of patients following cardiac surgery, and remains a
cause of major morbidity and mortality. While some preoperative risk
factors have been characterized, the influence of preoperative and
intraoperative factors on the occurrence of ARF following cardiac surgery
is less well understood. Methods. Preoperative and
intraoperative data on 2843 consecutive adult cardiopulmonary bypass (CPB)
from February 1, 1995 to February 1, 1997 were recorded and entered into a
computerized database. Two definitions of renal failure were employed: (i)
ARF defined as a rise in serum creatinine (Cr) of 1 mg/dl above baseline;
and (ii) ARF-D defined as the development of ARF for which some form of
dialytic therapy was required. The association between preoperative and
intraoperative variables and the development of ARF was assessed by
multivariate logistic regression. Results. A total of
2672 of the 2844 patients underwent isolated coronary artery bypass
grafting (CABG) surgery, the remaining 172 underwent valve surgery with or
without bypass grafting. Of the CABG patients 7.9% developed ARF and 0.7%
developed ARF-D. The mortality for patients who developed ARF was 14% (OR
15, P=0.0001) compared with 1% among those who did not
develop ARF. The mortality for CABG patients who developed ARF-D was 28%
(OR 20, P=0.0001) compared with 1.8% among those who
did not require dialysis. Variables that were significantly associated with
the development of ARF by multivariate analysis included: increased age,
elevated preoperative serum Cr, duration of CPB, presence of a carotid
artery bruit, presence of diabetes, reduced cardiac ejection fraction and
increased body weight. Variables independently associated with ARF-D
included serum Cr, duration of CPB, carotid artery bruit and presence of
diabetes. The utility of these models for predicting the development of ARF
and ARF-D was confirmed by bootstrapping techniques. Because of the small
numbers of patients who underwent valve surgery, none of these variables
were significantly associated with the development of ARF or ARF-D in this
group of patients. Conclusion. The development of ARF
of ARF-D is associated with a high mortality following CABG surgery. We
have identified perioperative variables, which may be useful in stratifying
risk for the development of ARF. Keywords: cardiac
surgery; haemodialysis; renal failure
ORIGINAL ARTICLES
Acute renal failure following cardiac surgery
Departments of Medicine, Anesthesia and Surgery, Duke University Medical Center, Durham, NC 27710, USA; Corresponding author address: Consultant Nephrologist, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland, UK
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