Intraoperative Continuous Venovenous Hemofiltration during Coronary Surgery

Abstract

Postoperative continuous venovenous hemofiltration decreases acute renal failure in patients with moderate renal dysfunction undergoing coronary artery bypass grafting, but it prolongs intensive care unit stay. We developed a simple method to connect a hemofiltration machine to the cardiopulmonary bypass system. To evaluate the benefit of intraoperative hemofiltration, 124 consecutive patients (mean age, 67 +/- 6 years) with moderate renal dysfunction were studied. Surgery was preformed between January 2005 and May 2007. On-pump coronary artery bypass with hemofiltration was carried out in 40 patients (group A), 44 had on-pump coronary artery bypass without hemofiltration (group B), and 40 had off-pump coronary artery bypass (group C). Postoperative acute renal failure was defined as either renal failure requiring dialysis or >or=50% decline from the baseline glomerular filtration rate but not requiring dialysis. The 3 groups had similar demographic data and preoperative renal function. After adjusting for covariates and propensity scores, multivariate analysis showed that intraoperative hemofiltration and off-pump surgery protected postoperative renal function. Independent risk factors for postoperative renal dysfunction were age >70 years, left ventricular ejection fraction <35%, and the preoperative glomerular filtration rate.

Cardiac Surgery-Associated Acute Kidney Injury

“…One study evaluated the effect of prophylactic hemofiltration on postoperative renal function in 124 consecutive patients with moderate preoperative renal dysfunction. The results showed that the patients with intraoperative prophylactic hemofiltration had better protection of renal function than the patients in the group without prophylactic hemofiltration [123]. A retrospective observational multicenter study enrolled data from 24 Spanish hospitals with 203 patients with AKI-RRT after cardiac surgery.…”

Prevention of Acute Kidney Injury in Children Undergoing Cardiac Surgery: A Narrative Review

“…A retrospective cohort study of 220 patients (aged 10 days to 19 years) demonstrated that an increase in Hb of >3g/dL from preoperative value on POD 1 was a significant risk factor (adjusted OR:6.94 [95% CI 2.33-20.69]) in the development of CS-AKI. 29 The effect of other modifications in CPB techniques, such as utilization of pulsatile CPB, 127 ultrafiltration, 128 and hemofiltration 129 during CPB on CS-AKI have only been predominantly described in the adult cardiac population. However, these have not been widely studied in children.…”

Hemofiltration and Hemodialysis in the Prevention and Treatment of Acute Renal Failure after Cardiac Surgery under Extracorporeal Circulation

“…и подключением ГФ во время ИК, СКФ по сле КШ снижалась незначительно, была сравнима с та ковой при операциях КШ «of pump». В группе ИК без ГФ, СКФ после операции была достоверно ниже [7]. В наше исследование включено меньше пациентов, кроме операций КШ имели место вмешательства на клапанах сердца и левом желудочке, доза замещения несколько больше, чем в приведенном исследовании.…”

“…В качестве профилактики ухудшения функции почек, развития послеоперационной ОПН у больных высоко го риска предложена интраоперационная ГФ [7]. В слу чае развития ОПН, процедуры ЗПТ применяют на ос новании абсолютных показаний и оценки тяжести ОПН согласно классификаций RIFLE (2004), AKIN (2007) [8].…”