Intraoperative hemodialysis during open-heart surgery in patients with severe chronic kidney disease: a retrospective

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Takahiro Inoue1, Hiroshi Kuji2, Kanako Nagaoka1

  • 1Department of Nephrology, Kameda Medical Center, 929, Higashicho, Kamogawa, Chiba, 296-8602, Japan.

BMC Nephrology
|March 29, 2023
PubMed

Insights

Intraoperative hemodialysis (IHD) during open-heart surgery did not improve overall clinical outcomes for patients with chronic kidney disease (CKD). However, IHD showed potential benefits for managing patients with stage G4 CKD post-surgery.

Area of Science:

  • Nephrology
  • Cardiology
  • Surgical Critical Care

Background:

  • Acute kidney injury and chronic kidney disease (CKD) significantly increase mortality risk after cardiac surgery.
  • The effect of intraoperative hemodialysis (IHD) on renal function post-cardiac surgery is not well understood.
  • This study investigates IHD's utility in severe non-dialysis-dependent CKD (CKD-NDD) patients undergoing open-heart surgery.

Purpose of the Study:

  • To evaluate the effectiveness of intraoperative hemodialysis (IHD) in patients with severe chronic kidney disease (CKD-NDD) undergoing open-heart surgery.
  • To assess the association of IHD with postoperative renal function and overall clinical outcomes.

Main Methods:

  • Single-center retrospective cohort study.
  • Included patients with CKD stage G4 or G5 undergoing non-emergency open-heart surgery.
  • Compared outcomes between patients receiving IHD and those not receiving IHD; primary outcomes were 90-day mortality and postoperative renal replacement therapy (RRT) initiation.

Main Results:

  • No significant differences in 90-day mortality or 30-day RRT rates between IHD and non-IHD groups.
  • Among patients with CKD G4, the IHD group showed significantly lower 30-day RRT rates (0% vs. 25.0%, p=0.032).
  • IHD did not significantly decrease overall poor clinical outcomes, but RRT initiation was less likely for CKD G4 patients.

Conclusions:

  • Intraoperative hemodialysis (IHD) did not improve overall clinical outcomes or reduce postoperative dialysis needs in CKD-NDD patients.
  • IHD may offer benefits for postoperative cardiac management specifically in patients with CKD stage G4.
  • Further research is needed to clarify the role of IHD in specific CKD populations undergoing cardiac surgery.
Abstract

Keywords:
Acute kidney injuryCardiac surgeryChronic kidney diseaseIntraoperative hemodialysis

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