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      Acute Renal Failure after Cardiothoracic Surgery: A Review of Three Years Experience

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          Abstract

          2,683 cardiothoracic operations were carried out over a 3-year period. Patients requiring haemofiltration after surgery had a much greater mortality than those not haemofiltered. Of the 1,177 cardiothoracic intensive care unit (ICU) patients, 91 required haemofiltration for acute renal failure (ARF; 7.7%). Of the 1,506 cardiothoracic high-dependency unit patients 13 were transferred to the renal unit for dialysis (0.86%). Mortality for cardiothoracic patients overall was 14.4% and for those who required haemofiltration 58.7%. 74 of these haemofiltered patients had normal renal function preoperatively; mortality 61%. 15 patients had pre-existing renal impairment; mortality 53.3%. 15 patients were on dialysis prior to surgery; mortality 60%. Age was not a predictor of requirement for renal replacement therapy or of mortality. Operation type was a risk factor for ARF: of patients having a coronary artery bypass graft (CABG) 2.4% were filtered (mortality 37.8%), of patients having valve replacements 14.2% were haemofiltered (mortality 60.9%), and of the patients having redo-CABGs or redo-valve replacements 12.3% required haemofiltration (mortality 100%).

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          Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery.

          The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Medical record analysis with collection of demographic, clinical, and outcome information was used. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.
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            Author and article information

            Journal
            BPU
            Blood Purif
            10.1159/issn.0253-5068
            Blood Purification
            S. Karger AG
            978-3-8055-7371-9
            978-3-318-00812-8
            0253-5068
            1421-9735
            2002
            2002
            27 February 2002
            : 20
            : 3
            : 293-295
            Affiliations
            Department of Renal Medicine, Middlesex Hospital, London, UK
            Article
            47023 Blood Purif 2002;20:293–295
            10.1159/000047023
            11867878
            © 2002 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Tables: 2, References: 5, Pages: 3
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/47023
            Categories
            Proceedings of the 6th International Conference on CRRT

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