Risk Factors for Development of Acute Renal Failure (ARF) Requiring Dialysis in Patients Undergoing Cardiac Surgery

Abstract

Acute renal failure (ARF) is one of the major complications after cardiopulmonary bypass for open heart operations. The present study was undertaken to identify the risk factors for the development of ARF following cardiopulmonary bypass (CPB). Four hundred and forty-seven consecutive patients who underwent open heart procedures from July 1994 to June 1995 were analyzed retrospectively. Their mean age was 55.6 +/- 14.2 (SD) years (range, 18 to 80). Dialysis was instituted whenever a patient exhibited inadequate urine output (<0.5 mL/kg/hr) for 2 to 3 hours despite correction of hemodynamic status and diuretic therapy, especially if fluid overload, hyperkalemia, or metabolic acidosis were also present. Twenty variables were analyzed by univariate analysis; these included nine preoperative variables--age, sex, hypertension, atherosclerosis, diabetes mellitus, left ventricular end-diastolic dimension (LVEDD) >5 cm, preoperative congestive heart failure, renal insufficiency (serum creatinine > or =130 micromol/L on two occasions), and sepsis--10 intraoperative variables--duration of CPB, redo procedures, emergency surgery, use of intraaortic balloon pump (IABP) in operating room, use of gentamicin, use of ceftriaxone, use of sulbactam/ampicillin, requirement of deep hypothermic circulatory arrest, duration of low mean perfusion pressure (mean pressure <50 mmHg for more than 30 minutes), operation on multiple valves--and one postoperative variable--significant hypotension (systolic blood pressure less than 90 mmHg for more than 1 hour). Significant variables or the variables having a trend (p<0.1) to be associated with ARF were included in stepwise multiple logistic regression analyses. Three regression analyses were performed separately. The incidence of ARF requiring dialysis in the study period was 15.0%. Significant risk factors for whole group of patients (regression I) were preoperative renal insufficiency (p<0.0001), postoperative hypotension (p<0.0001), cardiopulmonary bypass time more than 140 min (p<0.005), preoperative congestive heart failure (p<0.01), and history of diabetes mellitus (p<0.01). The risk factors in the valve group of patients (regression II) were preoperative renal insufficiency (p<0.0001) and postoperative hypotension (p<0.05). Risk factors in the CABG patients (regression III) were postoperative hypotension (p=0.0001), CPB time more than 140 min (p<0.05), preoperative renal insufficiency (p<0.05), and age (p<0.05). The authors conclude that preoperative renal insufficiency and postoperative hypotension are the most important independent risk factors for ARF in postcardiac surgical patients. In addition, CPB time greater than 140 minutes and old age are also independent risk factors for ARF in CABG patients. CPB time more than 140 minutes, history of diabetes mellitus, and preoperative congestive heart failure are independent risk factors for development of ARF in our total group of patients. These findings may have important clinical implications in the prevention of ARF in postcardiac su...

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

“…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. Need for inotropic drugs -need for dopamine or dobutamine, or both, from the immediate postoperative period until the second postoperative day.…”

“…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.…”