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Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury.
Michael W Manning1, Yi-Ju Li2, Dean Linder3
1Department of Anesthesiology & Critical Care, Duke University School of Medicine, Durham, NC.
Journal of Cardiothoracic and Vascular Anesthesia
|December 19, 2020
Summary
Conventional ultrafiltration (CUF) removal exceeding 32 mL/kg during cardiopulmonary bypass increases acute kidney injury (AKI) risk in cardiac surgery patients. CUF did not reduce blood transfusions.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Critical Care Medicine
Background:
- Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) aims to reduce allogeneic blood transfusions.
- Previous research linked CUF volume to postoperative acute kidney injury (AKI), but optimal weight-indexed thresholds were undefined.
Purpose of the Study:
- To determine optimal weight-indexed CUF volumes associated with postoperative AKI after cardiac surgery.
- To provide clinical guidance on CUF management during CPB.
Main Methods:
- Retrospective cohort study of 1,641 patients undergoing elective cardiac surgery.
- Investigated association between dichotomized weight-indexed CUF volumes and AKI development.
- Used Kidney Disease: Improving Global Outcomes criteria for AKI staging.
Main Results:
- Postoperative AKI occurred in 50.4% of patients.
- Higher CUF volumes (e.g., >32.6 mL/kg or ≥32.9 mL/kg) significantly increased AKI risk (OR 1.68 and 1.60, respectively).
- Increased CUF volumes correlated with more allogeneic blood transfusions and longer hospital stays.
Conclusions:
- Weight-indexed CUF volumes exceeding 32 mL/kg are associated with increased postoperative AKI risk.
- CUF volume removal did not mitigate allogeneic blood transfusions in elective cardiac surgery.
- Further prospective studies are required for validation.
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