Haemodialysis and haemofiltration on cardiopulmonary bypass.

Hakim, Mohammed; Wheeldon, D.; Bethune, D.W.; Milstein, B. B.; English, T. A. H.; Wallwork, J.

doi:10.1136/thx.40.2.101

Cited by 33 publications

(16 citation statements)

References 7 publications

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“…Our controlled study demonstrates a significant benefit of IHD compared to RHD in the prevention or attenuation of hyperkalemia and metabolic acidosis, mini mization of intraoperative fluid gain and avoidance of the risks of early postoperative hemodialysis. We found that postoperative hemodialysis could be delayed for an addi tional 24 h by IHD when compared to RH D. These findings are consistent with those of Soffer [1], Zawada [4] and Hakim [8] where postoperative hemodialysis could easily be delayed in IHD patients until the third postoperative day.…”

Section: Discussionsupporting

confidence: 82%

Intraoperative versus Routine Hemodialysis in End-Stage Renal Disease Patients Undergoing Open-Heart Surgery

Ilson

Bland²,

Jorkasky³

et al. 1992

Nephron

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Of 13 chronic hemodialysis end-stage renal disease (ESRD) patients undergoing open-heart surgery, 7 received intraoperative hemodialysis (IHD) during cardiopulmonary bypass and 6 received hemodialysis on a routine basis (RHD). Within the groups, IHD patients had significantly lower post-operative mean serum potassium and mean plasma creatinine concentrations compared to mean preoperative values. Postoperative mean BUN tended to decrease and mean serum bicarbonate concentration was unchanged as compared to mean preoperative values. In the RHD group, however, post-operative mean serum potassium concentration tended to increase, mean serum bicarbonate concentration significantly declined and mean BUN was unchanged as compared to mean preoperative values. An average of 2.1 ± 0.5 liters of fluid was removed from the IHD patients during cardiopulmonary bypass. Post-operatively, 0 of 7 IHD patients versus 4 of 6 RHD patients required parenteral sodium bicarbonate therapy (eχ², p < 0.01). On average, RHD patients required hemodialysis 1 day after surgery, whereas IHD patients were hemodialyzed 2 days after surgery (p = 0.009). We conclude that IHD lessened postoperative hyperkalemia and metabolic acidosis and delayed postoperative hemodialysis by an additional day. IHD should be considered as an adjunct to RHD therapy in the management of ESRD patients undergoing open-heart surgery.

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Section: Discussionsupporting

confidence: 82%

Intraoperative versus Routine Hemodialysis in End-Stage Renal Disease Patients Undergoing Open-Heart Surgery

Ilson

Bland²,

Jorkasky³

et al. 1992

Nephron

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“…Hence, UF with hemofiltration during CPB may theoretically be more efficient in the management of intraoperative fluid overload, hyperkalemia, and uremia than hemofiltration alone. [3] A one-year survival rate of between 83 and 95% has been reported for dialysis patients undergoing CABG alone. [12,13] However, when CABG was combined with valve replacement, the ratio declined to 70%, [14] and five-year survival rates have been chronicled as low as 20%.…”

Section: Resultsmentioning

confidence: 99%

“…Bearing this in mind, various strategies, such as perioperative hemodialysis and hemofiltration, have been successful in producing favorable surgical outcomes. [2,3] Ultrafiltration is a technique that removes plasma water and low-molecular-weight solutes by a connective process using hydrostatic forces across a semipermeable membrane. Conventional UF usually begins at the initiation of the surgery and lasts until the end of the cardiopulmonary bypass (CPB).…”

mentioning

confidence: 99%

The effects of perioperative ultrafiltration on postoperative outcomes in dialysis-dependent patients undergoing open heart surgery

Çoşkun¹

2013

Turk Gogus Kalp Dama

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Amaç: Bu çalışmada açık kalp cerrahisi yapılan hemodiyalize bağımlı hastalarda perioperatif ultrafiltrasyonun (UF) ameliyat sonrası sonuçları üzerine etkileri araştırıldı. Ça lış mapla nı:Mart 2000 -Mayıs 2008 tarihleri arasında açık kalp ameliyatı yapılan hemodiyalize bağımlı 46 hasta çalışmaya dahil edildi. Hastalar ultrafiltrasyon (UF) kullanımına göre iki gruba ayrıldı: UF (+) ve UF (-) grubu. Tüm hastalar ameliyattan bir gün önce ve ameliyattan iki gün sonra hemodiyalize alındı. Kırk altı hastanın 26'sına ameliyat sırasında UF yapıldı (UF (+) grubu). Her iki grubun yoğun bakımda kalış süresi dahil olmak üzere, hastanede kalış süreleri ve morbidite ve mortalite oranları karşılaştı-rıldı. Ameliyat öncesi ve sonrası santral venöz basınçları, kan üre nitrojen (BUN), kreatinin, serum potasyum ve hemoglobin (Hgb) konsantrasyonları incelendi. Bul gu lar: Yoğun bakımda kalış süresi (sırasıyla 56±28 saat ve 95±93 saat; p= 0.04) ve hastanede kalış süresi (sırasıyla 5.5±1.4 gün ve 8.1±3.4 gün; p= 0.002) gruplar arasında anlamlı olarak farklı idi. Gruplar arasında ameliyat sonrası ortalama BUN (sırasıyla 50.6±13.5 mg/dl ve 59.8±13.7 mg/dl; p= 0.02) ve hemoglobin düzeylerinde (sırasıyla 9.9±1.0 g/dl ve 8.8±0.9 g/dl; p= 0.001) anlamlı farklılıklar vardı. So nuç:Diyalize bağımlı hastalarda açık kalp perioperatif UF uygulaması, hastanede kalış süresini kısaltabilir ve biyokimyasal ve hemodinamik parametrelerde iyileşme sağlayabilir.Anah tar söz cük ler: Diyalize bağımlı hasta; açık kalp cerrahisi; ultrafiltrasyon.

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“…It is possible that the bene its of intraoperative hemo iltration (conventional or modi ied ultra iltration) can be explained by the elimination of in lammatory mediators during the metabolic stressful period of coronary bypass, as demonstrated in studies before [6][7][8][9][10]. In addition, there is also evidence to suggest that intraoperative hemo iltration reduces levels of S100b release and cognitive dysfunction [11], resulting in an earlier tracheal extubation following cardiopulmonary bypass [12].…”

Section: Discussionmentioning

confidence: 99%

“…Hemo iltration was introduced in the 1980s for CPB management [6][7][8][9], and has been shown in pediatric cardiac surgery to be effective at regulating hemostasis, removal of cytokines and complement components [10]. Similarly, in adults zerobalance hemo iltration was shown to be effective at removing in lammatory mediators during CPB [10,11].…”

Section: Introductionmentioning

confidence: 99%

The Risk-Adjusted Impact of Intraoperative Hemofiltration on Real-World Outcomes of Patients Undergoing Cardiac Surgery

BM¹

2017

J Clini Nephrol

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Objectives: The role of perioperative hemofi ltration (HF) in adult patients with impaired renal function undergoing cardiac surgery is controversial. There are suggestions that it may be benefi cial for high risk patients undergoing prolonged cardiopulmonary bypass (CPB) surgery. However, long term outcomes in coronary artery bypass graft (CABG) surgery patients have not been investigated. Methods:To address this we retrospectively followed 7620 patients who underwent CABG between April 2001 and March 2006. Logistic regression was used to risk adjust in-hospital outcomes. Cox proportional hazards analysis was used to risk adjust Kaplan-Meier freedom from death curves. Outcomes were adjusted for American Heart Association and American College of College of Cardiology recommended variables.Results: 113 patients had intraoperative HF, 38 had postoperative HF and control group of 7006 that had no HF. After adjusting for differences in case-mix, patients with preoperative kidney disease who received postoperative HF proportionately had signifi cantly higher rates of hospital deaths as compared with intraoperative HF patients. In addition, 5-year follow-up risk-adjusted freedom from death indicated signifi cant differences between intraoperative HF group and postoperative HF patients. Conclusions:These fi ndings support the hypothesis that after adjusting for differences in case mixes, the use of intraoperative hemofi ltration may offer superior short term clinical outcomes and longer-term survival benefi ts for patients with preoperative kidney disease.

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Haemodialysis and haemofiltration on cardiopulmonary bypass.

Cited by 33 publications

References 7 publications

Intraoperative versus Routine Hemodialysis in End-Stage Renal Disease Patients Undergoing Open-Heart Surgery

Intraoperative versus Routine Hemodialysis in End-Stage Renal Disease Patients Undergoing Open-Heart Surgery

The effects of perioperative ultrafiltration on postoperative outcomes in dialysis-dependent patients undergoing open heart surgery

The Risk-Adjusted Impact of Intraoperative Hemofiltration on Real-World Outcomes of Patients Undergoing Cardiac Surgery

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