Acute renal failure following cardiac surgery

Area of Science:

• Nephrology
• Cardiology
• Surgical Outcomes

Background:

• Acute renal failure requiring dialysis (ARF-D) complicates 1.5% of cardiac surgeries, contributing significantly to morbidity and mortality.
• While some preoperative risk factors for ARF are known, perioperative influences remain less understood.

Purpose of the Study:

• To identify preoperative and intraoperative variables associated with the development of acute renal failure (ARF) and ARF requiring dialysis (ARF-D) after cardiac surgery.
• To assess the predictive utility of identified variables for ARF and ARF-D.

Main Methods:

• A multivariate logistic regression analysis was performed on preoperative and intraoperative data from 2843 adult patients undergoing cardiac surgery with cardiopulmonary bypass.
• Two definitions of renal failure were used: ARF (serum creatinine rise of 1 mg/dl) and ARF-D (ARF requiring dialysis).

Main Results:

• In coronary artery bypass grafting (CABG) patients, 7.9% developed ARF and 0.7% developed ARF-D, with significantly higher mortality in both groups.
• Multivariate analysis identified increased age, elevated preoperative serum creatinine, longer cardiopulmonary bypass duration, carotid artery bruit, diabetes, reduced ejection fraction, and increased body weight as associated with ARF.
• Serum creatinine, CPB duration, carotid artery bruit, and diabetes were independently associated with ARF-D.

Conclusions:

• Acute renal failure and ARF-D following CABG surgery are associated with substantial mortality.
• Identified perioperative variables can aid in stratifying patient risk for developing ARF after cardiac surgery.