Acute renal failure following cardiopulmonary bypass: a changing picture

Abstract

The need for CVVH following CPB may be diminishing despite increased risk factors. ARF-associated mortality in these circumstances is falling.

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

“…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.…”

“…Acute renal failure requiring dialysis (acute renal failure-D) after cardiac surgery, occurs from 0.5% to 15.0% [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]23,26 . Its occurrence in our study was 4.9% (11 cases), greater than that reported in other studies, apart from that of Suen et al 15 and of OR -odds ratio; CI -confidence interval; ECC -extracorporeal circulation.…”

“…Mortality related to acute renal failure-D reported in the literature varies from 23.9% to 88.9% [6][7][8][9][10][11][14][15][16]18,19 , and in the last 10 years, these values have varied from 23.9% to 63.7% 8,11,15,16,18,19 . The mortality rate observed in patients without acute renal failure was 1.6%, compared with 25.0% for those with it.…”

“…In 18.0% to 47.0% of cases, it is related to a surgical event, and acute tubular necrosis is the main type of lesion 1,2,4 . The great variation in the incidence of acute renal failure among the studies presents a multifactor profile, including different diagnostic criteria, such as the study design, inclusion and exclusion criteria, profile of the patients and of the centers involved in the sample, hindering study comparisons 5 .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.…”

“…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.…”