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Renal function changes after elective cardiac surgery with cardiopulmonary bypass.

E M de Moraes Lobo1, E A Burdmann, R C Abdulkader

  • 1Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.

Renal Failure
|July 20, 2000
PubMed
Summary

Cardiac surgery can impact kidney function. Patients with decreased glomerular filtration rate (GFR) after surgery often had prior valvular procedures, lower baseline sodium fractional excretion, and required more fluids.

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Area of Science:

  • Nephrology
  • Cardiology
  • Surgical Sciences

Background:

  • Cardiac surgery (CS) can affect renal function, potentially causing acute kidney injury or improving glomerular filtration rate (GFR) through enhanced cardiac performance.
  • Understanding renal function changes post-CS is crucial for patient management.

Purpose of the Study:

  • To prospectively evaluate renal function changes after elective cardiac surgery (CS) with cardiopulmonary bypass (CPBP).
  • To identify factors associated with GFR decrease or improvement post-CS.

Main Methods:

  • Prospective evaluation of 21 patients undergoing valvular CS (VCS) or coronary artery bypass (CAB) at three time points: pre-surgery, 24 hours post-surgery, and 48 hours post-surgery.
  • Patients were divided into two groups based on GFR change at 24 hours post-CS: Group 1 (deltaGFR24 decrease >20%) and Group 2 (deltaGFR24 decrease ≤20% or increase).

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  • Analysis included GFR, baseline fractional excretion of sodium (FENa), volume replacement, and medication use.

    • Main Results:

    • Group 1 (GFR decrease) had a higher prevalence of VCS (73%) and prior CS (100%) compared to Group 2.
    • Group 1 required significantly more volume replacement (2,699 mL vs. 217 mL) and had lower GFR at 24 hours post-CS (39 mL/min vs. 75 mL/min).
    • Lower baseline FENa (0.27% vs. 0.70%) correlated with GFR decrease, suggesting a renal response to low effective blood volume.

    Conclusions:

    • Patients experiencing GFR decrease post-CS were more likely to have undergone VCS, had prior CS, lower baseline FENa, and required more volume infusion and nitroprusside.
    • No tubular dysfunction was detected in the early post-operative period.
    • Observed renal function changes likely represent an appropriate renal response to low effective blood volume, with low baseline FENa predicting GFR decrease.