Prophylactic Dialysis in Elderly Patients Undergoing Coronary Bypass Surgery

Abstract

Renal dysfunction is associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery (CABG), especially in elderly patients. In the current study, we aimed to determine the impact of prophylactic preoperative hemodialysis on operative outcome in patients with mild renal dysfunction. Between March 2002 and May 2005 a total of 64 patients, all of whom were more than 70 years of age and with preoperative creatinine levels greater than 2 mg/dL, underwent primary elective on pump coronary artery bypass surgery. The mean age was 76.3 +/- 6.4 (range 70-83). The patients were prospectively allocated into two groups. Group A was the dialysis group (31 patients) and preoperative prophylactic hemodialysis was carried out in all patients. Group B (33 patients) was taken as a control group without preoperative hemodialysis. During the present study, 10 patients died (15.6%) in the hospital. In the postoperative period mean levels of creatinine were found to be decreased in dialysis group. (2.3 +/- 0.8 mg/dL vs. 3.4 +/- 0.2 mg/, P = 0.037). The incidence of overall morbidity (such as acute renal failure, need of postoperative dialysis, low cardiac output and multiple organ failure) were also found to be decreased in dialysis group. We conclude from the present study that preoperative renal dysfunction and advanced age increase the risk of mortality and morbidity after on-pump coronary artery bypass surgery. We believe that perioperative prophylactic hemodialysis is an easy and effective method and it decreases both operative mortality and morbidity in elderly patients with renal dysfunction.

Effect of Prophylactic Dialysis on Morbidity and Mortality in Non-Dialysis-Dependent Patients after Coronary Artery Bypass Grafting: A Pilot Study

“…This difference in age may explain the discrepancies between the 2 studies. The difference in baseline serum creatinine and duration of hemodialysis may also explain why our results are different from the study of Bingol et al [20]. …”

“…In a randomized study by Bingol et al [20], prophylactic hemodialysis was performed 3 times over 72 h prior to surgery in patients aged >70 years with a serum creatinine level >2 mg/dL. They observed an in-hospital mortality rate of 9.6% in patients who received prophylactic dialysis compared with 21.2% in patients who did not receive dialysis.…”

“…In the same study, serum creatinine levels before surgery were higher than those observed in this study (2.5 vs. 2.3 mg/dL), and the length of each dialysis treatment was 4-5 h compared with 2-4 h in our study. In an observational study by Bingol et al [20], the postoperative morbidity was significantly lower in patients who received dialysis. The average age of patients in this study was 64 years, whereas the average age of patients in the study by Bingol et al [20] was 70 years.…”

“…In an observational study by Bingol et al [20], the postoperative morbidity was significantly lower in patients who received dialysis. The average age of patients in this study was 64 years, whereas the average age of patients in the study by Bingol et al [20] was 70 years. This difference in age may explain the discrepancies between the 2 studies.…”

Peri-operative renal protective strategies in cardiac surgery

“…The pre-operative prophylactic use of RRT on patients with sCr >2-2.5 mg/dL has been shown to decrease morbidity and mortality in two randomised controlled trials 11,12 . However, the cost-effectiveness of pre-operative prophylactic use of RRT is required to be further studied.…”