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Published on: October 2, 2020
Hemodiafiltration during cardiac surgery in patients on chronic hemodialysis
Atsushi Fukumoto1, Masaaki Yamagishi, Kiyoshi Doi
1Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kaiji-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. fukumoto@koto.kpu-m.ac.jp
Insights
Intraoperative hemodiafiltration (HDF) in chronic dialysis patients undergoing cardiac surgery significantly reduced postoperative complications and mortality. This innovative HDF protocol also enabled earlier patient extubation and ambulation, leading to shorter hospital stays.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Patients on chronic hemodialysis undergoing cardiac surgery face risks of fluid imbalance and bleeding.
- A novel hemodiafiltration (HDF) protocol was developed to manage these risks.
- This study retrospectively evaluated the outcomes of this HDF protocol.
Purpose of the Study:
- To assess the efficacy of an intraoperative hemodiafiltration (HDF) protocol.
- To evaluate its impact on postoperative morbidity and mortality in patients on chronic dialysis undergoing cardiac surgery.
Main Methods:
- Retrospective study of 33 chronic dialysis patients undergoing cardiac surgery (including 19 off-pump CABG).
- Vascular access via femoral vein catheter; HDF initiated at surgery start.
- HDF continued post-procedure to achieve target hematocrit, CVP, and serum potassium levels.
Main Results:
- Zero in-hospital mortality observed.
- No instances of postoperative wound infection, mediastinitis, respiratory tract infection, or hemorrhage.
- Patients discharged at a mean of 15.6 days post-operation.
Conclusions:
- Intraoperative HDF appears to reduce postoperative morbidity and mortality in chronic dialysis patients.
- The protocol facilitates early extubation and ambulation.
- Shortened hospitalization duration is a significant benefit.
Background:
We have developed a hemodiafiltration (HDF) protocol used during cardiac surgery to preserve fluid and electrolyte balance and prevent postoperative bleeding in patients on chronic hemodialysis. This retrospective study examined the operative results associated with our new protocol.
Methods:
The study included 33 consecutive patients on long-term hemodialysis who underwent cardiac surgery at our hospital between January 2001 and April 2005, including off-pump coronary artery bypass grafting (CABG) in 19 patients. Vascular access was achieved via a 12-French double-lumen catheter inserted into the left femoral vein under general anesthesia, and HDF begun when the operation was started. After completion of cardiopulmonary bypass or, in patients who underwent off-pump CABG, after the distal anastomoses were completed, HDF was continued until target hematocrit between 30% and 35%, central venous pressure between 3 and 5 mmHg, and serum potassium concentration between 3.0 and 3.5 mEq/L were reached. The chest was closed after confirmation of hemostasis.
Results:
There was no in-hospital death. Three patients were extubated in the operating room. There were no postoperative wound infection, mediastinitis, respiratory tract infection, or hemorrhage. The patients were discharged at a mean of 15.6 days after operation.
Conclusions:
These results suggest that intraoperative HDF lowers postoperative morbidity and mortality in chronic dialysis patients. Other advantages include early extubation and ambulation, and a shortened hospitalization.
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