Renal function after cardiac surgery: adverse effect of furosemide

Renal failure is a frequent event after cardiopulmonary by-pass. Hemodynamic alterations that occur during surgery, as well as factors depending on the host, are the main risk factors for renal dysfunction. To evaluate the frequency and risk factors for renal dysfunction in this setting, a cohort of fifty patients with preoperative serum creatinine under 1.5 mg/dL, submitted to cardiac surgery with cardiopulmonary by-pass was analyzed. Variables related to preoperative patient condition, intraoperative and postoperative periods were recorded. Renal function was assessed by clearances of creatinine, urea and free water, also by fractional excretion of sodium (FENa), at baseline, at anesthetic induction and during postoperative period. Patients were arbitrarily divided in two groups, according to the serum creatinine (S(Cr)) value at the end of the postoperative period: Group 1: S(Cr) < 2 mg/dL (n = 44 patients (88.5%)) and Group II: S(Cr) > 2 mg/dL (n = 6 patients (11.5%)). A decrease of renal function was observed in all patients: creatinemia raised from 1.04 +/- 0.2 to 1.55 +/- 0.4 mg/dL (33%), associated with a rise in FENa. Differences between group I and group II using univariate analysis were: baseline serum creatinine (1.01 +/- 0.23 mg/dL vs. 1.26 +/- 0.19 mg/dL, p = 0.03), FENa (0.99 +/- 0.8 vs. 2.2 +/- 2.1, p = 0.04), furosemide dose during surgery normalized to body surface area (93.2 +/- 23 mg/1.73 m2 BSA vs. 135 +/- 38 mg/1.73 m2 BSA, p < 0.001), and hemodilution index (17.3 +/- 4.3% vs. 22.8 +/- 3.2%, p < 0.01). In the multiple regression model, baseline creatinemia and furosemide dose were associated to renal dysfunction.