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Continuous renal replacement therapy in cardiac surgery

Continuous renal replacement therapy in cardiac surgery. Presenter: Ri 謝佳憲. Content. Base-line and intra-operative variables Long-term and short term outcomes Timing of CRRT. Background. ARF necessitating the use of CRRT is a rare but a devastating complication of cardiac surgery

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Continuous renal replacement therapy in cardiac surgery

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  1. Continuous renal replacement therapy in cardiac surgery Presenter: Ri 謝佳憲

  2. Content • Base-line and intra-operative variables • Long-term and short term outcomes • Timing of CRRT

  3. Background • ARF necessitating the use of CRRT is a rare but a devastating complication of cardiac surgery • Incidence: 2-15% • Mortality: 40-80%

  4. Etiology • Poorly understood • Hypo-perfusion of the renal medulla seems to be the most likely mechanism. • Nephrotoxic agents, ex. AG, vancomycin • Tissue oedema, microembolization..

  5. Base-line and intra-operative variables

  6. Baseline variables • Definition: serum Cr>1 mg/dl above baseline. • Associated with the development of ARF following CABG

  7. Intra-operative variables • Associated with the development of ARF following CABG

  8. Conclusion • Increased age, black race, carotid bruit, CHF, CVA history, DM, decreased LVEF, increased serum Cr, peripheral arterial disease, increased BW, CPB duration, IABP inserted.

  9. Type of surgery v.s Mortality rate

  10. Long-term and short-term outcomes

  11. Short-term outcome • Lango et al.: 30% in-hospital mortality with high volume CRRT. • Bent et al.: 40% mortality with early and intensive CRRT. • An 80% mortality was reported when CRRT was instituted over a week post-operatively.

  12. Long-term outcome • Only 2.2% patients require long term CRRT. • The long term survival(5 years) was as good as the early survival(1 year).

  13. Conclusion • Short-term use: improve mortality rate • Long-term use: not needed

  14. Timing of CRRT

  15. Timing of CRRT • Two Groups: 1. 27 patients, started when Cr>5mg/dl, or K>5.5mEq/L. 2. 34 patients, when UOP<100ml within consecutive 8 hrs, with no response to 50mg furosemide.

  16. Intra- and post op variables

  17. Conclusion • The sooner the ARF after surgery is recognized and CVVHDF is performed, the higher the likelihood of reduction of the hospital mortality. • Renal failure could easily be recognized with Group 2 criteria, thus CRRT could be started ASAP.

  18. Reference • Acute renal failure following cardiac surgery. Nephrol Dial Transplant(1999)14:1158-62 • Long and short-term outcomes in patients requiring continuous renal replacement therapy post cardiopulmonary bypass. European Journal of Cardio-thoracic surgery 27(2005)906-909 • Timing of Replacement Therapy for Acute Renal Failure After Cardiac Surgery. J Card Surg 2004;19:17-20 • Continuous renal replacement therapy after cardiac surgery. Bloodpurification.22(3):249-55,2004.

  19. Thanks for your attention!

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