Early Continuous Venovenous Hemodialysis in Dialysis-Dependent Patients After Cardiac Surgery: Safety and Efficacy

doi:10.1053/j.jvca.2006.02.003

Journal of Cardiothoracic and Vascular Anesthesia

Volume 21, Issue 3, June 2007, Pages 379-383

https://doi.org/10.1053/j.jvca.2006.02.003 Get rights and content

Objectives: The present study assessed the safety and efficacy of continuous venovenous hemodialysis (CVVHD) early after cardiac surgery.

Design: Retrospective database and medical record review.

Setting: University teaching hospital.

Participants: Forty-five dialysis-dependent patients who underwent cardiac surgery with cardiopulmonary bypass.

Interventions: CVVHD was begun postoperatively after confirmation of hemostasis, irrespective of circulatory status. In the last 5 patients, the ratio of extravascular lung water (EVLW) to intrathoracic blood volume (ITBV) was measured using a single-indicator thermodilution catheter and compared with patients of normal renal function undergoing cardiac surgery.

Measurements and Main Results: CVVHD was started at 4 hours after ICU admission. The maximum decrease in blood pressure within 60 minutes after initiation of CVVHD was 11 ± 9 mmHg in the unstable hemodynamics group (defined as patients who required continuous intravenous adrenaline or intra-aortic balloon pump on admission to the ICU [n = 15]) and 7 ± 8 mmHg in the stable hemodynamics group (n = 30, not significant). Circulatory status and oxygenation improved significantly 12 hours after CVVHD initiation in the unstable hemodynamics group. Blood volume from the chest tube did not increase after CVVHD. Early mortality (2.2%) was lower than that reported previously. The EVLW/ITBV ratio after ICU admission in dialysis-dependent patients was significantly higher than in patients with normal renal function.

Conclusions: Early CVVHD after cardiac surgery in dialysis-dependent patients was safe and effective. There was no associated increased postoperative bleeding or hemodynamic instability. Fluid removal improved respiratory status, particularly in patients requiring circulatory assistance, and overall early morality rates were lower that those previously published.

Section snippets

Methods

Medical records of 45 dialysis-dependent patients undergoing cardiac surgery with CPB between 1997 and 2004, at Osaka City University Hospital, Osaka, Japan, were retrospectively examined. The standard of care during this period was consistent under the same chief cardiac surgeon, intensivists, and anesthetic management regimen. Patients who were on peritoneal dialysis were excluded from this study because preoperative fluid and solute conditions were quite different between peritoneal dialysis

Results

Perioperative patients’ demographic data are summarized in Table 1. Twenty-seven patients underwent valvular surgery including single- or double-valve replacement with or without coronary artery bypass graft (CABG) surgery. CVVHD was started at 4 (3.00) hours after ICU admission and lasted for 28 (22.75) hours. The objective to extubate patients, within 24 hours of ICU admission, and to have them discharged from the ICU by the second postoperative day, was achieved in 19 patients. There were 15

Discussion

In most institutions, hemodialysis is generally restarted on the first or second postoperative day for patients with stable hemodynamics6, 9, 10 because conventional hemodialysis can cause hemodynamic instability due to rapid and massive removal of fluids and solutes. Peritoneal dialysis can be used for such patients but is occasionally ineffective because of the reduced blood flow in the omentum.⁹ Moreover, the upward displacement of the diaphragm by a large volume of intra-abdominal dialysate

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Coronary Artery Bypass Grafting in Dialysis-Dependent Patients – Key Peri-Operative Considerations
2023, Cardiovascular Revascularization Medicine
Cardiovascular disease represents the leading cause of mortality in dialysis-dependent (DD) patients, with the great majority of these patients afflicted by severe coronary artery disease. As rates of end-stage renal disease increase worldwide, DD patients represent a growing proportion of the coronary artery bypass grafting (CABG) cohort. Yet, these patients are complex, with crucial changes in their haemodynamic and physiologic profiles that complicate revascularisation surgery. First, this comprehensive literature review explores the outcomes and prognostic factors for DD patients undergoing CABG. We then summarise the intricacies relating to important peri-operative decisions such as use of cardio-pulmonary bypass and choice of conduit.
Secular trends in acute dialysis after elective major surgery - 1995 to 2009
2012, CMAJ. Canadian Medical Association Journal
Citation Excerpt :
Alternatively, nephrologists today may be consulted earlier in the course of a patient's illness than before, dialysis may be more readily available, and the threshold for starting dialysis may be lower.28–31 This last practice may have been influenced by recent studies suggesting that starting dialysis earlier may improve prognosis.29,32–35 Unfortunately, despite the trends in increasing use of dialysis and starting it earlier, survival has remained poor.
Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time.
We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function.
A total of 552 672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15–0.2) to 0.6% in 2009 (95% CI 0.6–0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0–44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8–29.7), with no change over time.
The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed.
Continuous Hemodiafiltration in Children After Cardiac Surgery
2011, Artificial Organs

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Original articleEarly Continuous Venovenous Hemodialysis in Dialysis-Dependent Patients After Cardiac Surgery: Safety and Efficacy

Section snippets

Methods

Results

Discussion

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Am J Kidney Dis

Am J Med

Ann Thorac Surg

Chest

Ann Thorac Surg

Kidney Int

The current state of chronic dialysis treatment in Japan (as of December 3, 2000)

Ther Apher Dial

Early results and characteristics problems associated with cardiac surgery in long-term dialysis patients

Jpn J Thorac Cardiovasc Surg

Original article
Early Continuous Venovenous Hemodialysis in Dialysis-Dependent Patients After Cardiac Surgery: Safety and Efficacy