Acute on Chronic Renal Failure has Worse Postoperative Outcomes than End-Stage Renal Disease Following Cardiac Surgery

Abstract

Background: Renal failure is a systemic disorder and has destructive effects among all organs including cardiovascular system. The development of postoperative acute kidney injury has been recognized as one of the strongest risk factor for mortality in patients undergoing cardiac surgery. Aim/Objective: To investigate postoperative course of acute on chronic renal failure after cardiac surgery and defi ne perioperativerisk factors for predicting postoperative acute renal failure (ARF) development. Materials and Methods: From January 2006 to December 2014, data of 3038 patients undergone cardiac surgery was retrospectively reviewed. Data of 42 chronic renal failure (CRF) patients who undergone dialysis at early postoperative period (≤30 days after cardiac surgery) were selected and evaluated. Group 1 (n=18) was consisted of patients who have preoperative dialysis dependent CRF and undergone dialysis after cardiac surgery, while Group 2 (n=24) was consisted of patients who have preoperative dialysis nondependent CRF and undergone dialysis after cardiac surgery. Preoperative clinical characteristics and demographics, operational data of patients as well as postoperative outcomes of patient groups were analyzed, hereby a comparison of two groups was performed. Results: There were not statistically difference between groups for neuropsychiatriccomplications, wound infectious complications, septiccomplications, reexploration, duration of ventilation, cardioversion, intraaortic balloon pump support, pleural effusion, pericardial effusion and total drainage amounts. Positive inotropic necessity, signifi cant electrocardiographicchanges, reintubation necessity and transfusion amounts were statistically higher in Group 2. Patients in Group 2 had a signifi cant longer intensive care unit (ICU) stay (mean length of ICU stay was 4 days in Group 1, while 6 days in Group 2, p = 0.01) and total hospital stay (mean length of total hospital stay was 9 days in Group 1, while 15 days in Group 2, p = 0.006). Thirty-day mortality rate was statistically higher in Group 2 (p = 0.044). Conclusion: End stage renal failure is one of the worst preoperative risk factor for cardiac surgery but postoperative ARF development results with worst outcomes even patients had preoperative dialysis non-dependent CRF. So preoperative estimated glomerular fi ltration rate should be calculated to estimate ARF development risk, instead of evaluating with only serum creatinine.

Ultrastructural examination of left internal mammary artery under electron microscopy in patients with chronic kidney disease who underwent coronary bypass surgery

“…Although mortality rates are higher in CKD patients compared to normal population, satisfactory results can be achieved if these patients are operated with correct indications when diagnosed with coronary artery disease. Today CABG operations can be performed with very low morbidity and mortality rates [8][9][10][11]. Positive results were obtained from all studies conducted on patency rates on IMA and examination of its histomorphological features.…”

“…Capability to widely and successfully perform topic that these operations could also be performed in patients with accompanying highrisk group diseases of other systems. Today, in patients with chronic kidney disease, coronary artery bypass grafting (CABG) surgery has been gradually increased and successfully performed [8][9][10][11]. Structural and functional properties of conduits during the surgical myocardial revascularization is of important issue which affects the success of the surgery [12,13].…”

Effect of Incentive Spirometry on Pulmonary Function Tests in Patients Undergoing Hemodialysis: A Randomized Clinical Trials

“…It is among major causes of death and disability [1]. CRF is a systemic disorder with destructive effects on all organs [2]. The kidneys perform many crucial functions including regulation of water and blood pressure, and acid-base and electrolyte balance, and participation in hormones functions.…”