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

BM, Matata

doi:10.29328/journal.jcn.1001001

Cited by 3 publications

(3 citation statements)

References 40 publications

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“…The use of intraoperative hemofiltration may be beneficial to the patient in the short term as well as to patients with preoperative renal dysfunction in the long term [49]. Additionally, it may also be recommended for patients with previous liver disease [36].…”

Section: Discussionmentioning

confidence: 99%

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

et al. 2020

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Introduction Hyperlactatemia occurs during or after extracorporeal circulation in the form of lactic acidosis, increasing the risk of postoperative complications and the mortality rate. The aim of this study was to evaluate whether continuous high-volume hemofiltration with volume replacement through a polyethersulfone filter during the extracorporeal circulation procedure decreases postoperative lactatemia and its consequences. Materials and methods This was a randomized controlled trial. Patients were randomly divided into two groups of 32: with or without continuous high-volume hemofiltration through a polyethersulfone membrane. Five patients were excluded from each group during the study period. The sociodemographic characteristics, filter effects, and blood lactate levels at different times during the procedure were evaluated. Secondary endpoints were studied, such as the reduction in the intubation time and time spent in ICU. Results Lactatemia measurements performed during the preoperative and intraoperative phases were not significantly different between the two groups. However, the blood lactate levels in the postoperative period and at 24 hours in the intensive care unit showed a significant reduction and a possible clinical benefit in the hemofiltered group. Following extracorporeal circulation, the mean lactate level was higher (difference: 0.77 mmol/L; CI 0.95: 0.01–1.53) in the nonhemofiltered group than in the hemofiltered group (p<0.05). This effect was greater at 24 hours (p = 0.019) in the nonhemofiltered group (difference: 1.06 mmol/L; CI 0.95: 0.18–1.93) than in the hemofiltered group. The reduction of lactatemia is associated with a reduction of inflammatory mediators and intubation time, with an improvement in liver function. Conclusions The use and control of continuous high-volume hemofiltration through a polyethersulfone membrane during heart-lung surgery could potencially prevent postoperative complications. The reduction of lactatemia implied a reduction in intubation time, a decrease in morbidity and mortality in the intensive care unit and a shorter hospital stay.

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Section: Discussionmentioning

confidence: 99%

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

et al. 2020

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“…This can facilitate kidney function after weaning from CPB. The literature reports no difference [117] or positive outcomes [118] of applying intraoperative hemofiltration regarding kidney function. This discrepancy may be due to the application of zero balance ultrafiltration in the study by Matata et al [118] and the lack of data regarding fluid balance in the study by Kandil et al [117].…”

Section: Fluid Balance and Osmotic Regulationmentioning

confidence: 98%

“…The literature reports no difference [117] or positive outcomes [118] of applying intraoperative hemofiltration regarding kidney function. This discrepancy may be due to the application of zero balance ultrafiltration in the study by Matata et al [118] and the lack of data regarding fluid balance in the study by Kandil et al [117]. All in all, the available data suggest that intraoperative hemofiltration can be beneficial for kidney function, especially in patients with decreased preoperative filtration rate.…”

Section: Fluid Balance and Osmotic Regulationmentioning

confidence: 98%

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Udzik,

Pacholewicz,

Biskupski

et al. 2023

JCM

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Introduction: According to different authors, cardiac surgery-associated acute kidney injury (CSA-AKI) incidence can be as high as 20–50%. This complication increases postoperative morbidity and mortality and impairs long-term kidney function in some patients. This review aims to summarize current knowledge regarding alterations to renal physiology during cardiopulmonary bypass (CPB) and to discuss possible nephroprotective strategies for cardiac surgeries. Relevant sections: Systemic and renal circulation, Vasoactive drugs, Fluid balance and Osmotic regulation and Inflammatory response. Conclusions: Considering the available scientific evidence, it is concluded that adequate kidney perfusion and fluid balance are the most critical factors determining postoperative kidney function. By adequate perfusion, one should understand perfusion with proper oxygen delivery and sufficient perfusion pressure. Maintaining the fluid balance is imperative for a normal kidney filtration process, which is essential for preserving the intra- and postoperative kidney function. Future directions: The review of the available literature regarding kidney function during cardiac surgery revealed a need for a more holistic approach to this subject.

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Evaluation of non-response to the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey

Dad

Tighiouart

Fenton

et al. 2018

BMC Health Serv Res

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BackgroundThe In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) Survey is the first patient reported outcome measure included in the U.S. Medicare End Stage Renal Disease Quality Incentive Program. Administered twice yearly, it assesses in-center dialysis experience and survey responses are tied to dialysis facility payments. Low response rates, currently approximately 35%, raise concern for possible underrepresentation of patient groups.MethodsCross-sectional analysis of survey administration in 2012 to all in-center hemodialysis patients in Dialysis Clinic, Inc. (DCI) facilities nationally over 18 years old who received hemodialysis at their facility for at least 3 months. Patient-level covariates included demographic, clinical, laboratory, and functional characteristics. Random effects multivariable logistic regression was used to assess survey non-response.ResultsAmong 11,055 eligible patients 6541 (59%) were non-responders. Of the remaining 4514 responders, 549 (14%) surveys were not usable due to presence of proxy help or incomplete responses. Non-responders were more likely to be men, non-white, younger, single, dual Medicare/Medicaid eligible, less educated, non-English speaking, and not active on the transplant list; non-responders had longer ESRD vintage, lower body mass index, lower serum albumin, worse functional status, and more hospitalizations, missed treatments, and shortened treatments. Similar associations were found using more parsimonious multivariable analyses and after imputing missing data.ConclusionsNon-responders to the ICH CAHPS significantly differed from responders, broadly spanning individuals with fewer socioeconomic advantages and greater illness burden, raising limitations in interpreting facility survey results. Future research should assess reasons for non-response to improve ICH CAHPS generalizability and utility.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3618-4) contains supplementary material, which is available to authorized users.

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

Cited by 3 publications

References 40 publications

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Evaluation of non-response to the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey

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