Acute renal failure following cardiac surgery: incidence, outcomes and risk factors

Abstract

These data confirm that ARF following cardiac surgery is uncommon without pre-operative impairment of renal function but currently carries a mortality rate of 13%. Impaired renal function alone is associated with higher mortality and prolonged hospital stay. Studies to prevent ARF in this setting should focus on the high risk subsets described in this study.

Insuficiência renal aguda após cirurgia de revascularização miocárdica com circulação extracorpórea: incidência, fatores de risco e mortalidade

“…In the present study, we considered serum creatinine variation as an index of renal function decrease; however, it is known that an increase in serum creatinine is a not very sensitive estimation of the decrease in renal function, because small increases may reflect substantial decreases in renal function, due to the exponential correlation curve between serum creatinine and renal function 5,25 , just as the reduction in muscular mass, occurring with aging, leads to a reduction in the production of creatinine and consequently in decreased serum levels of creatinine. The elderly, therefore, may have normal levels of serum creatinine, with creatinine clearance as low as 30 mL/min 4 .…”

“…Mortality ranges from 3.5% to 31.0% [5][6][7][8][9][10][11][12][16][17][18][19]23 , and this variation may be because of the criteria used for its diagnosis: the number and characteristics of hospitals involved in each study, the patients' features, and the size of the sample 11,24 . These aspects hinder data comparison among the several studies performed.…”

“…The presence of acute renal failure in these patients increases the mortality rate from 0.4% to 4.4% to 1.3% to 22.3%, and when dialysis is required, these rates reach 25.0% to 88.9% [5][6][7][8][9][10][11][12][13][14][15][16][17][18] , making it an independent risk factor for mortality, according to Chertow et al 16 , and increasing 8-fold the death odds ratio among these patients.…”

“…In cardiac surgery, its incidence ranges from 3.5% to 31.0% [5][6][7][8][9][10][11][12] , and the need for dialysis occurs in 0.3% to 15.0% of cases [5][6][7][8][9][10][11][12][13][14][15][16][17][18] . The presence of acute renal failure in these patients increases the mortality rate from 0.4% to 4.4% to 1.3% to 22.3%, and when dialysis is required, these rates reach 25.0% to 88.9% [5][6][7][8][9][10][11][12][13][14][15][16][17][18] , making it an independent risk factor for mortality, according to Chertow et al 16 , and increasing 8-fold the death odds ratio among these patients.…”

“…Patients who present with reduced renal functional reserve, in whom a reduction occurs in the glomerular filtration rate without serum creatinine elevation above normal values, are more likely to have ARF even with minor renal lesions 16 . Preoperative and intraoperative factors, such as age, previous level of creatinine, diabetes mellitus, cardiac output, the duration of extracorporeal circulation, and the use of the intraaortic balloon, are influencial in the development of ARF [5][6][7][8][10][11][12]19 . The severity of ARF may increase with the occurrence of complications in the postoperative period, such as infections, hemorrhage, and the use of nephrotoxic substances 20 .…”