Immediate and Long-Term Results of Coronary Artery Bypass Operation in Hemodialysis Patients

Osaka, Shin-ichi; Osawa, Hajime; Miyazawa, Masaaki; Honda, Jiro

doi:10.1046/j.1525-1594.2001.025004252.x

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…Much like the primary cause of failure in hemodialysis AV grafts and fistulae in the upper extremities, stenosis due to NH is a major reason for failure of bypass grafts (e.g., synthetic grafts and autologous veins) in the lower extremities. 19,20 For instance, the patency rates for lower extremity bypass grafts are 40% to 78% in 3 yr in the general population, [21][22][23] but the patency rates of bypass grafts in CKD patients is significantly less 24,25 approaching the patency rates of 17% to 34% at 2 yr associated with hemodialysis AV grafts and fistulae. 2 While our animals (stage 3 to 4 CKD) did not have end stage kidney disease, the anastomotic NH lesions in our murine model have the characteristics of the occlusive NH lesions found in human hemodialysis AV fistula.…”

Section: Discussionmentioning

confidence: 99%

CKD Accelerates Development of Neointimal Hyperplasia in Arteriovenous Fistulas

Kokubo

Ishikawa

Uchida

et al. 2009

Journal of the American Society of Nephrology

108

100

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Arteriovenous (AV) access failure resulting from venous neointimal hyperplasia is a major cause of morbidity in patients with ESRD. To understand the role of chronic kidney disease (CKD) in the development of neointimal hyperplasia, we created AV fistulae (common carotid artery to jugular vein in an end-to-side anastomosis) in mice with or without CKD (renal ablation or sham operation). At 2 and 3 wk after operation, neointimal hyperplasia at the site of the AV anastomosis increased 2-fold in animals with CKD compared with controls, but cellular proliferation in the neointimal hyperplastic lesions did not significantly differ between the groups, suggesting that the enhanced neointimal hyperplasia in the setting of CKD may be secondary to a migratory phenotype of vascular smooth muscle cells (VSMC). In ex vivo migration assays, aortic VSMC harvested from mice with CKD migrated significantly greater than VSMC harvested from control mice. Moreover, animals with CKD had higher serum levels of osteopontin, which stimulates VSMC migration. When we treated animals with bone morphogenic protein-7, which promotes VSMC differentiation, before creation of the AV anastomosis, the effect of CKD on the development of neointimal hyperplasia was eliminated. In summary, CKD accelerates development of neointimal hyperplasia at the anastomotic site of an AV fistula, and administration of bone morphogenic protein-7 neutralizes this effect.

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Section: Discussionmentioning

confidence: 99%

CKD Accelerates Development of Neointimal Hyperplasia in Arteriovenous Fistulas

Kokubo

Ishikawa

Uchida

et al. 2009

Journal of the American Society of Nephrology

108

100

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“…Others have described the use of continuous modalities such as CRRT in parallel to CPB instead of HD [28]. Finally, some groups use a mix of these different modalities, typically with preoperative HD, intraoperative HD, then postoperative CRRT [21,29,30]. One group reports that implementing a protocol that delivers pre-, intra-, and postoperative dialytic therapy (various modalities) can significantly reduce the high morbidity and mortality typically seen in this patient population (compared to matched controls) [30].…”

Section: Intraoperative Managementmentioning

confidence: 99%

Optimizing Perioperative Renal Replacement Therapy for Patients Undergoing Cardiac Surgical Procedures Requiring Cardiopulmonary Bypass

et al. 2022

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Coronary artery disease is highly prevalent in patients with end-stage renal disease (ESRD), and cardiovascular complications remain the most common cause of death in this patient population. Accordingly, many cardiac surgical procedures requiring cardiopulmonary bypass support are performed on these patients each year, with morbidity and mortality rates far exceeding patients without ESRD. Anuric patients lack the normal renal homeostatic functions which typically allow for physiologic protection from challenges during the operation, such as volume overload, hyperkalemia, and acidemia. Careful preoperative planning and coordination to provide pre-, intra-, and postoperative renal replacement therapies for such patients are imperative. Many different strategies have been reported in the literature. Zero-balance ultrafiltration is a newer strategy which utilizes convective ultrafiltration much like pre-filter continuous renal replacement therapy and utilizes pre-existing connections on the cardiopulmonary bypass pump performed by the perfusion team. This allows for control of potassium concentration throughout the operation with existing personnel and minimal additional equipment. Here, we describe the unique challenges caring for patients receiving renal replacement therapy undergoing cardiac surgical procedures requiring cardiopulmonary bypass.

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