Minimized extracorporeal circulation cannot prevent acute kidney injury but attenuates early renal dysfunction after...

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Critical Care Medicine

Background:

• Coronary bypass grafting often involves cardiopulmonary bypass, which can lead to acute kidney injury (AKI).
• Minimized extracorporeal circulation (MECC) is an alternative to conventional extracorporeal circulation (ECC) with potential hemodynamic benefits.

Purpose of the Study:

• To evaluate the impact of MECC versus conventional ECC on the incidence of AKI after coronary bypass grafting.
• To assess the secondary outcome of temporary dialysis requirement and mortality risk associated with preoperative renal function.

Main Methods:

• Retrospective observational study involving 1,685 patients undergoing MECC and 3,046 patients undergoing conventional ECC.
• Primary outcome: AKI defined as a decline of >= 50% in estimated glomerular filtration rate (eGFR) within 48 hours post-surgery.
• Secondary outcomes: Temporary dialysis and 30-day mortality.

Main Results:

• Fewer patients in the MECC group experienced a decline in eGFR <60 mL/min/1.73 m(2) compared to the ECC group (30.7% vs. 45.5%, p < 0.001).
• The incidence of AKI (eGFR decrease >= 50%) did not significantly differ between groups (1.8% vs. 2.7%, p = 0.20).
• Temporary dialysis was required less often in the MECC group (0.9% vs. 2.0%, p < 0.001).
• Preoperative eGFR <60 mL/min/1.73 m(2) significantly increased mortality risk in both groups.

Conclusions:

• MECC demonstrates renoprotective effects in the early postoperative period after coronary bypass grafting, evidenced by reduced need for dialysis.
• MECC does not prevent the occurrence of acute kidney injury.
• Preoperative renal function impairment is a critical predictor of mortality, irrespective of the cardiopulmonary bypass system used.