Acute renal failure in the patient undergoing cardiac operation

Zanardo, G.; Michielon, Paolo; Paccagnella, Agostino; Rosi, Paolo; Calò, M.; Salandin, V.; Ros, Antonia Da; Michieletto, Federica; Simini, G.

doi:10.1016/s0022-5223(94)70429-5

Cited by 354 publications

(124 citation statements)

References 17 publications

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“…It has been shown that patients with normal pre‐operative renal function do not show a fall in glomerular filtration rate postoperatively [15,16]. We have confirmed this in patients on ACEIs.…”

Section: Discussionsupporting

confidence: 80%

Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors

Bennett

McKeown

Drew

et al. 2001

European J of Heart Fail

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Background: Patients presenting for cardiac surgery are often treated with angiotensin converting enzyme inhibitors Ž . Ž . ACEIs , either for heart failure or hypertension. Control of systemic vascular resistance SVR during surgery can be difficult in such patients. Angiotensin II has been available as an unlicensed vasoconstrictor, but there is concern about renal damage and its use. Aim: This study compared a standard vasoconstrictor with angiotensin II and examined the effect on renal function after cardiac surgery. Method: Twenty consecutive, consenting patients scheduled for cardiac surgery that had been taking ACEIs for at least 6 months, were randomly assigned to receive either phenylephrine or angiotensin II for the control of SVR during and for 24 h after cardiac surgery. A pulmonary artery catheter was used to guide therapy. Creatinine clearance was measured before, 24 and 48 h after surgery. Results: Low SVR and blood pressure requiring intervention was seen in all patients, particularly during cardiopulmonary bypass. One patient in the control group failed to respond to P, but responded normally to angiotensin II. Neither drug caused renal impairment. Conclusion: Angiotensin II is a safe alternative to phenylephrine in patients on ACEIs and should be considered in patients who fail to respond to conventional vasoconstrictors. ᮊ

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Section: Discussionsupporting

confidence: 80%

Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors

Bennett

McKeown

Drew

et al. 2001

European J of Heart Fail

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“…If statin use leads to any clinically significant rhabdomyolysis in the perioperative period, one would assume that it would also lead to an increase in the incidence of postoperative renal failure. This would be a special concern in patients undergoing cardiac surgeries because increasing age [6–12] and the use of cardiopulmonary bypass [11,12] have both been associated with an increased risk for postoperative renal insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Statin Therapy Decreases Risk of Postoperative Renal Insufficiency

Virani

Nambi

Polsani

et al. 2010

Cardiovascular Therapeutics

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Introduction: Although current guidelines recommend withholding statins in perioperative patients, little information is available on whether perioperative statin use increases risk for postoperative renal failure. Aims: We examined the relation between preoperative statin therapy and postoperative risk for renal insufficiency in patients undergoing cardiac surgery. Methods: Retrospective cohort review from the Texas Heart Institute research database was performed. Patients were divided into two groups: those who received preoperative statins and those who did not. Primary outcome was the development of postoperative renal insufficiency (requiring dialysis or not). Outcomes were assessed in the entire cohort and in subgroups undergoing isolated coronary artery bypass grafting (CABG), isolated valve surgery, or combined CABG and valve surgery. Results: Of 3001 patients, 56% received preoperative statins. In multivariate logistic regression analysis, preoperative statins were associated with significant reductions in risk for postoperative renal insufficiency in the entire cohort (odds ratio [OR] = 0.60, 95% confidence interval [CI] 0.38-0.95) and in patients undergoing isolated CABG (OR = 0.34, 95% CI 0.17-0.68). In patients undergoing isolated valve surgery (OR = 1.35, 95% CI 0.61-2.96) or combined CABG and valve surgery (OR = 1.39, 95% CI 0.48-3.99), preoperative statins were not associated with decreased incidence of postoperative renal insufficiency. Age >65 years, preoperative renal insufficiency, history of congestive heart failure, preoperative intra-aortic balloon pump insertion, and total cardiopulmonary bypass time >80 min were also independent predictors associated with increased risk for postoperative renal insufficiency. Conclusions: Preoperative statin therapy was associated with decreased incidence of postoperative renal insufficiency in patients undergoing cardiac surgeries, particularly in patients undergoing isolated CABG.

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“…This is true in patients with even mild renal impairment [6, 10]. Patients who develop acute renal insufficiency or worsening of their baseline renal function after an acute myocardial infarction (MI) [13, 14], in coronary care units [15], after coronary bypass surgery [16] and other cardiac operations [17–20] have been shown to have a higher mortality than those who do not develop acute renal insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Renal failure after percutaneous coronary intervention is associated with high mortality

Gupta

Gurm

Bhatt

et al. 2005

Cathet Cardio Intervent

145

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Renal failure is a marker of poor outcome in the general population. Renal failure after percutaneous coronary artery intervention (PCI) is associated with an increased hazard of in-hospital mortality. We hypothesized that post-PCI renal insufficiency would be a predictor of long-term mortality in patients undergoing PCI who survive for over 30 days after the procedure. A retrospective analysis was conducted from a registry of 9,067 patients undergoing PCI at our center from 1997 to 2001. A rise in creatinine by 1 mg/dl from baseline was defined as post-PCI renal insufficiency. Vital status was assessed using Social Security Death Index. There were a total of 996 deaths over a mean follow-up period of 3.2 years. In a multivariate analysis, history of recent acute myocardial infarction, older age, insulin-dependent diabetes, baseline creatinine greater than 1.5 mg/dl, and presence of mitral regurgitation were associated with post-PCI renal insufficiency. Developing post-PCI renal insufficiency was associated with a 4.31-fold hazard of mortality in univariate analysis and a 1.77-fold hazard after adjustment for known predictors of mortality after PCI. The 1-year survival in patients with renal failure was 70.3% +/- 3.91%, compared to a survival of 93.6% +/- 0.27% in those without any post-PCI renal insufficiency (P < 0.0001). Acute renal insufficiency after PCI is a strong and independent predictor of long-term mortality in patients who survived for 30 days after the procedure.

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Acute renal failure in the patient undergoing cardiac operation

Cited by 354 publications

References 17 publications

Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors

Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors

Preoperative Statin Therapy Decreases Risk of Postoperative Renal Insufficiency

Renal failure after percutaneous coronary intervention is associated with high mortality

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