Document Detail


Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery.
MedLine Citation:
PMID:  12645707     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Preoperative creatinine values higher than 2.5 mg/dL are associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery. We aimed to determine the effects of prophylactic perioperative hemodialysis on operative outcome in patients with nondialysis-dependent moderate renal dysfunction. METHODS: Forty-four adult patients with creatinine levels greater than 2.5 mg/dL but not requiring dialysis underwent coronary artery bypass surgery with cardiopulmonary bypass. The patients were randomly divided into two groups. In group 1 (dialysis group, 21 patients), perioperative prophylactic hemodialysis was performed in all patients. Group 2 (23 patients) was taken as a control group and hemodialysis was performed only if postoperative acute renal failure was diagnosed. RESULTS: The hospital mortality was 4.8% (1 patient) in the dialysis group, and 30.4% (7 patients) in the control group (p = 0.048). Postoperative acute renal failure requiring hemodialysis was seen in 1 patient (4.8%) in the dialysis group and in 8 patients (34.8%) in the control group (p = 0.023). Thirty-three postoperative complications were observed in the control group for an early morbidity of 52.2% (12 patients) and 13 complications occurred in 8 patients in the dialysis group (38.1%). The average length of the intensive care unit and postoperative hospital stay were shorter in the dialysis group than in the control group (p = 0.005 and p = 0.023, respectively). CONCLUSIONS: Preoperative creatinine levels higher than 2.5 mg/dL, increase the risk of mortality and the development of acute renal failure and prolong the length of hospital stay after on-pump coronary artery bypass surgery. Perioperative prophylactic hemodialysis decreases both operative mortality and morbidity in these high-risk patients.
Authors:
Isa Durmaz; Tahir Yagdi; Tanzer Calkavur; Resad Mahmudov; Anil Z Apaydin; Hakan Posacioglu; Yüksel Atay; Cagatay Engin
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  75     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-03-20     Completed Date:  2003-04-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  859-64     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Ege University Medical Faculty, Bornova, Izmir, Turkey.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiopulmonary Bypass*
Cause of Death
Coronary Artery Bypass*
Creatinine / blood*
Female
Hospital Mortality
Humans
Kidney Failure, Acute / mortality,  prevention & control*
Kidney Failure, Chronic / mortality,  therapy*
Kidney Function Tests
Male
Middle Aged
Postoperative Complications / mortality,  prevention & control*
Preoperative Care*
Renal Dialysis*
Risk
Chemical
Reg. No./Substance:
60-27-5/Creatinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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