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Prophylactic dialysis in elderly patients undergoing coronary bypass surgery
Hakan Bingol1, Hakki Tankut Akay, Hikmet Iyem
1Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
Summary
Prophylactic preoperative hemodialysis significantly reduced mortality and morbidity in elderly patients undergoing coronary artery bypass surgery (CABG) with renal dysfunction. This intervention offers an effective strategy to improve operative outcomes in this high-risk group.
Area of Science:
- Cardiology
- Nephrology
- Geriatric Medicine
Background:
- Renal dysfunction elevates mortality and morbidity risks in patients undergoing coronary artery bypass surgery (CABG), particularly in the elderly.
- Mild renal dysfunction (creatinine > 2 mg/dL) in elderly patients undergoing CABG presents a significant surgical challenge.
Purpose of the Study:
- To evaluate the impact of prophylactic preoperative hemodialysis on operative outcomes in elderly patients with mild renal dysfunction undergoing elective CABG.
Main Methods:
- A prospective study of 64 patients (age > 70, creatinine > 2 mg/dL) undergoing primary elective on-pump CABG.
- Patients were divided into two groups: Group A (31 patients) received prophylactic preoperative hemodialysis, and Group B (33 patients) served as a control without preoperative hemodialysis.
Main Results:
- The dialysis group showed decreased postoperative creatinine levels (2.3 ± 0.8 mg/dL vs. 3.4 ± 0.2 mg/dL, P = 0.037).
- Incidence of overall morbidity, including acute renal failure, need for postoperative dialysis, low cardiac output, and multiple organ failure, was reduced in the dialysis group.
- Hospital mortality was 15.6% (10 patients).
Conclusions:
- Preoperative renal dysfunction and advanced age are significant risk factors for mortality and morbidity after on-pump CABG.
- Perioperative prophylactic hemodialysis is an effective and straightforward method to decrease operative mortality and morbidity in elderly patients with renal dysfunction undergoing CABG.
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