| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2005;129:391-400
© 2005 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology |
a Department of Anesthesia, University Health Network, University of Toronto
b Department of Health Policy, Management, and Evaluation, University of Toronto
c Department of Surgery, Division of Cardiovascular Surgery, University Health Network, University of Toronto
d Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Received for publication January 11, 2004; revisions received June 2, 2004; accepted for publication June 22, 2004. * Address for reprints: Keyvan Karkouti, MD, MSc, Department of Anesthesia, 3 Eaton N, Toronto General Hospital, University Health Network, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4 (E-mail: keyvan.Karkouti{at}uhn.on.ca).
BACKGROUND: This observational study sought to determine whether the degree of hemodilution during cardiopulmonary bypass is independently related to perioperative acute renal failure necessitating dialysis support.
METHODS: Data were prospectively collected on consecutive patients undergoing cardiac operations with cardiopulmonary bypass from 1999 to 2003 at a tertiary care hospital. The independent relationship was assessed between the degree of hemodilution during cardiopulmonary bypass, as measured by nadir hematocrit concentration, and acute renal failure necessitating dialysis support. Multivariate logistic regression was used to control for variables known to be associated with perioperative renal failure and anemia.
RESULTS: Of the 9080 patients included in the analysis, 1.5% (n = 134) had acute renal failure necessitating dialysis support. There was an independent, nonlinear relationship between nadir hematocrit concentration during cardiopulmonary bypass and acute renal failure necessitating dialysis support. Moderate hemodilution (nadir hematocrit concentration, 21%-25%) was associated with the lowest risk of acute renal failure necessitating dialysis support; the risk increased as nadir hematocrit concentration deviated from this range in either direction (P = .005). Compared with moderate hemodilution, the adjusted odds ratio for acute renal failure necessitating dialysis support with severe hemodilution (nadir hematocrit concentration <21%) was 2.34 (95% confidence interval, 1.47-3.71), and for mild hemodilution (nadir hematocrit concentration >25%) it was 1.88 (95% confidence interval, 1.02-3.46).
CONCLUSIONS: Given that there is an independent association between the degree of hemodilution during cardiopulmonary bypass and perioperative acute renal failure necessitating dialysis support, patient outcomes may be improved if the nadir hematocrit concentration during cardiopulmonary bypass is kept within the identified optimal range. Randomized clinical trials, however, are needed to determine whether this is a cause-effect relationship or simply an association.
This article has been cited by other articles:
|
|
 |
|
  Y. Abu-Omar and D. P. Taggart The present status of off-pump coronary artery bypass grafting Eur. J. Cardiothorac. Surg., August 1, 2009; 36(2): 312 - 321. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. De Somer Optimal Versus Suboptimal Perfusion During Cardiopulmonary Bypass and the Inflammatory Response Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2009; 13(2): 113 - 117. [Abstract] [PDF]
|
|
|
|
 |
|
 G. S. Murphy, E. A. Hessel II, and R. C. Groom Optimal Perfusion During Cardiopulmonary Bypass: An Evidence-Based Approach Anesth. Analg., May 1, 2009; 108(5): 1394 - 1417. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Boodhwani, F. D. Rubens, D. Wozny, and H. J. Nathan Effects of mild hypothermia and rewarming on renal function after coronary artery bypass grafting. Ann. Thorac. Surg., February 1, 2009; 87(2): 489 - 495. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H Vermeer, S Teerenstra, R. de Sevaux, H. van Swieten, and P. Weerwind The effect of hemodilution during normothermic cardiac surgery on renal physiology and function: a review Perfusion, November 1, 2008; 23(6): 329 - 338. [Abstract] [PDF]
|
|
|
|
|
|
G. M. T. Hare, A. K. Y. Tsui, A. T. McLaren, T. E. Ragoonanan, J. Yu, and C. D. Mazer Anemia and Cerebral Outcomes: Many Questions, Fewer Answers Anesth. Analg., October 1, 2008; 107(4): 1356 - 1370. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-Y. Yu, J.-Y. Li, S. Sun, K.-Y. Hung, J.-L. Wang, Y.-S. Chen, S.-S. Wang, and F.-Y. Lin Late dialysis rate for coronary artery bypass grafting patients with moderate-to-severe renal impairment: comparison between off-pump and conventional method Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 364 - 369. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ranucci, A. Pazzaglia, C. Bianchini, G. Bozzetti, and G. Isgro Body Size, Gender, and Transfusions as Determinants of Outcome After Coronary Operations Ann. Thorac. Surg., February 1, 2008; 85(2): 481 - 486. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Karkouti, D. N. Wijeysundera, W. S. Beattie, and for the Reducing Bleeding in Cardiac Surgery (RBC) Risk Associated With Preoperative Anemia in Cardiac Surgery: A Multicenter Cohort Study Circulation, January 29, 2008; 117(4): 478 - 484. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Rosner, D. Portilla, and M. D. Okusa Analytic Reviews: Cardiac Surgery as a Cause of Acute Kidney Injury: Pathogenesis and Potential Therapies J Intensive Care Med, January 1, 2008; 23(1): 3 - 18. [Abstract] [PDF]
|
|
|
|
 |
|
 S. J. Durham and J. P. Gold Late Complications of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 535 - 548. [Full Text]
|
|
|
|
|
|
M. Ranucci Perioperative Renal Failure: Hypoperfusion During Cardiopulmonary Bypass? Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 265 - 268. [Abstract] [PDF]
|
|
|
|
|
|
M. Di Mauro, M. Gagliardi, A. L. Iaco, M. Contini, A. Bivona, P. Bosco, S. Gallina, and A. M. Calafiore Does Off-Pump Coronary Surgery Reduce Postoperative Acute Renal Failure? The Importance of Preoperative Renal Function Ann. Thorac. Surg., November 1, 2007; 84(5): 1496 - 1502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Van der Linden, J.-F. Hardy, A. Daper, A. Trenchant, and S. G. De Hert Cardiac surgery with cardiopulmonary bypass: does aprotinin affect outcome? Br. J. Anaesth., November 1, 2007; 99(5): 646 - 652. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Habib, A. Zacharias, and T. A. Schwann Minimally Invasive Closed Circuit Versus Standard Cardiopulmonary Bypass: Is It Renoprotective? Ann. Thorac. Surg., October 1, 2007; 84(4): 1426 - 1427. [Full Text] [PDF]
|
|
|
|
|
|
F. Pappalardo, C. Corno, A. Franco, G. Giardina, A.M. Scandroglio, G. Landoni, G. Crescenzi, and A. Zangrillo Reduction of hemodilution in small adults undergoing open heart surgery: a prospective, randomized trial Perfusion, September 1, 2007; 22(5): 317 - 322. [Abstract] [PDF]
|
|
|
|
|
|
T. J. Gardner To Transfuse or Not to Transfuse Circulation, July 31, 2007; 116(5): 458 - 460. [Full Text] [PDF]
|
|
|
|
|
|
A. Kulier, J. Levin, R. Moser, G. Rumpold-Seitlinger, I. C. Tudor, S. A. Snyder-Ramos, P. Moehnle, D. T. Mangano, and for the Investigators of the Multicenter Study of Impact of Preoperative Anemia on Outcome in Patients Undergoing Coronary Artery Bypass Graft Surgery Circulation, July 31, 2007; 116(5): 471 - 479. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. N. Wijeysundera, K. Karkouti, J.-Y. Dupuis, V. Rao, C. T. Chan, J. T. Granton, and W. S. Beattie Derivation and Validation of a Simplified Predictive Index for Renal Replacement Therapy After Cardiac Surgery JAMA, April 25, 2007; 297(16): 1801 - 1809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ranucci, C. Bellucci, D. Conti, A. Cazzaniga, and B. Maugeri Determinants of Early Discharge From the Intensive Care Unit After Cardiac Operations Ann. Thorac. Surg., March 1, 2007; 83(3): 1089 - 1095. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Johannes, E. G. Mik, B. Nohe, K. E. Unertl, and C. Ince Acute decrease in renal microvascular PO2 during acute normovolemic hemodilution Am J Physiol Renal Physiol, February 1, 2007; 292(2): F796 - F803. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D. Mazer, F. Briet, K. R. Blight, D. J. Stewart, M. Robb, Z. Wang, A. M. Harrington, W. Mak, X. Li, and G. M.T. Hare Increased cerebral and renal endothelial nitric oxide synthase gene expression after cardiopulmonary bypass in the rat J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 13 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. G. Shann, D. S. Likosky, J. M. Murkin, R. A. Baker, Y. R. Baribeau, G. R. DeFoe, T. A. Dickinson, T. J. Gardner, H. P. Grocott, G. T. O'Connor, et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: A focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 283 - 290.e3. [Full Text] [PDF]
|
|
|
|
|
|
Y. Abu-Omar and C. Ratnatunga Cardiopulmonary Bypass and Renal Injury Perfusion, July 1, 2006; 21(4): 209 - 213. [Abstract] [PDF]
|
|
|
|
|
|
M. Ranucci, G. Isgro, F. Romitti, S. Mele, B. Biagioli, and P. Giomarelli Anaerobic Metabolism During Cardiopulmonary Bypass: Predictive Value of Carbon Dioxide Derived Parameters Ann. Thorac. Surg., June 1, 2006; 81(6): 2189 - 2195. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Habib, A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. S. Shah Postoperative Renal Dysfunction After On-Pump Versus Off-Pump Coronary Revascularization: Role of On-Pump Hemodilution and Transfusions Ann. Thorac. Surg., April 1, 2006; 81(4): 1548 - 1549. [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Rosner and M. D. Okusa Acute Kidney Injury Associated with Cardiac Surgery Clin. J. Am. Soc. Nephrol., January 1, 2006; 1(1): 19 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Bahar, A. Akgul, M. A. Ozatik, K. M Vural, A. E Demirbag, M. Boran, and O. Tasdemir Acute renal failure following open heart surgery: risk factors and prognosis Perfusion, December 1, 2005; 20(6): 317 - 322. [Abstract] [PDF]
|
|
|
|
|
|
K. A Samolyk, S. R Beckmann, and R. C Bissinger A new practical technique to reduce allogeneic blood exposure and hospital costs while preserving clotting factors after cardiopulmonary bypass: the Hemobag(R) Perfusion, December 1, 2005; 20(6): 343 - 349. [Abstract] [PDF]
|
|
|
|
|
|
M. Ranucci, F. Romitti, G. Isgro, M. Cotza, S. Brozzi, A. Boncilli, and A. Ditta Oxygen Delivery During Cardiopulmonary Bypass and Acute Renal Failure After Coronary Operations Ann. Thorac. Surg., December 1, 2005; 80(6): 2213 - 2220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Karkouti, G. Djaiani, M. A. Borger, W. S. Beattie, L. Fedorko, D. Wijeysundera, J. Ivanov, and J. Karski Low Hematocrit During Cardiopulmonary Bypass is Associated With Increased Risk of Perioperative Stroke in Cardiac Surgery Ann. Thorac. Surg., October 1, 2005; 80(4): 1381 - 1387. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
