Risks and opportunities to prevent acute renal failure in patients after cardiac surgery

Abstract

Острая почечная недостаточность (ОПН) после опе-раций на сердце является достаточно частым осложнени-ем. Она встречается у 19-45% больных, перенесших ис-кусственное кровообращение (ИК) [8], а при ее развитии риски летального исхода увеличиваются от 3 до 18 раз [9,12]. В последние годы в мировой литературе публикуют большое количество работ, посвященных этой проблеме.В то же время все публикации сводятся преимущественно к оценке причин развития ОПН с использованием регрес-сионного анализа. Нами проведен анализ частоты ОПН с попыткой сформировать «простые критерии», увеличива- Material and methods. It was analyzed treatment of 152 patients operated for heart valve and concomitant diseases. Acute renal failure developed in 50 (32.8%) patients. They were included into the main group. Control group consisted of patients without acute renal failure (n=102).Results. It was found that patients of the main group were older (61.8±9.6 vs. 53.1±13.3 years), more likely to suffer coronary heart disease (36.0% vs. 23.5%), hypertensive disease degree 3 (54.0% vs. 30.4%), diabetes (18.0% vs 7.8%). There were longer duration of cardiopulmonary bypass (133.2±48.6 vs. 118.5±53.8 min) and higher frequency of maze-procedures in this group (20.0% vs. 9.8%). Patients with acute renal failure had higher mortality rate (10.0% vs. 2.9%) and need for catecholamine support (18.8% vs. 8.8%). Assessment of risks of concomitant complications according to severity of acute renal failure showed increase of mortality compared with control group in Injury and Failure stages (RIFLE classification) 4 and 17 times respectively. It is shown that presence of compromised kidney facilitates renal dysfunction after 60 minutes of CPB and without it -after about 100 minutes of CPB. Also prolonged CPB increases risk of severe acute renal failure.