This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (36) Citing Articles via Google Scholar Google Scholar Articles by Provenchère, S. Articles by Philip, I. Search for Related Content PubMed PubMed Citation Articles by Provenchère, S. Articles by Philip, I. Related Collections Cardiovascular Heart Monitoring (Cardiac) Monitoring (Non-cardiac)

---

CARDIOVASCULAR ANESTHESIA

Renal Dysfunction After Cardiac Surgery with Normothermic Cardiopulmonary Bypass: Incidence, Risk Factors, and Effect on Clinical Outcome

Sophie Provenchère, MD^*, Gaetan Plantefève, MD^*, Gilles Hufnagel, MD, Eric Vicaut, MD, Cyrille de Vaumas, MD^*, Jean-Baptiste Lecharny, MD^*, Jean-Pol Depoix, MD^*, François Vrtovsnik, MD, Jean-Marie Desmonts, MD^*, and Ivan Philip, MD^*

*Département Anesthésie-Réanimation and Service de Néphrologie, Hôpital Bichat-Claude Bernard; and Laboratoire de Biophysique, Hôpital Fernand Widal, Paris, France

Address correspondence and reprint requests to S. Provenchère, MD, Département d’Anesthésie, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75877 Paris Cedex 18, France. Address e-mail to sophie.provenchere{at}bch.ap-hop-paris.fr

Renal dysfunction is a frequent and severe complication after conventional hypothermic cardiac surgery. Little is known about this complication when cardiopulmonary bypass (CPB) is performed under normothermic conditions (e.g., more than 36°C). Thus, we prospectively studied 649 consecutive patients undergoing coronary artery bypass surgery or valve surgery with normothermic CPB. The association between renal dysfunction (defined as a 30% preoperative-to-maximum postoperative increase in serum creatinine level) and perioperative variables was studied by univariate and multivariate analysis. Renal dysfunction occurred in 17% of the patients. Twenty-one (3.2%) patients required dialysis. Independent preoperative predictors of this complication were: advanced age, ASA class >3, active infective endocarditis, radiocontrast agent administration <48 h before surgery, and combined surgery. When all the variables were entered, active infective endocarditis, radiocontrast agent administration, postoperative low cardiac output, and postoperative bleeding were independently associated with renal dysfunction. The in-hospital mortality rate was 27.5% when this complication occurred (versus 1.6%; P < 0.0001). Furthermore, postoperative renal dysfunction was independently associated with in-hospital mortality (odds ratio, 4.1 [95% confidence interval, 1.3–12.8]). We conclude that advanced age, active endocarditis, and recent (within 48 h) radiocontrast agent administration, as well as postoperative hemodynamic dysfunction, are more consistently predictive of postoperative renal dysfunction than CPB factors.

IMPLICATIONS: We found that postoperative renal dysfunction was a frequent and severe complication after normothermic cardiac surgery, independently associated with poor outcome. Independent predictors of this complication were advanced age, active endocarditis, and recent (within 48 h) radiocontrast agent administration (the only preoperative modifiable factor), as well as postoperative hemodynamic dysfunction.

This article has been cited by other articles:

				A. F. Popov, J. Hinz, E. G. Schulz, J. D. Schmitto, C. H. Wiese, M. Quintel, R. Seipelt, and F. A. Schoendube The eNOS 786C/T polymorphism in cardiac surgical patients with cardiopulmonary bypass is associated with renal dysfunction Eur. J. Cardiothorac. Surg., October 1, 2009; 36(4): 651 - 656. [Abstract] [Full Text] [PDF]

				B. G. Loef, A. H. Epema, G. Navis, T. Ebels, and C. A. Stegeman Postoperative renal dysfunction and preoperative left ventricular dysfunction predispose patients to increased long-term mortality after coronary artery bypass graft surgery Br. J. Anaesth., June 1, 2009; 102(6): 749 - 755. [Abstract] [Full Text] [PDF]

				W. K. Han, G. Wagener, Y. Zhu, S. Wang, and H. T. Lee Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery Clin. J. Am. Soc. Nephrol., May 1, 2009; 4(5): 873 - 882. [Abstract] [Full Text] [PDF]

				K. Karkouti, D. N. Wijeysundera, T. M. Yau, J. L. Callum, D. C. Cheng, M. Crowther, J.-Y. Dupuis, S. E. Fremes, B. Kent, C. Laflamme, et al. Acute Kidney Injury After Cardiac Surgery: Focus on Modifiable Risk Factors Circulation, February 3, 2009; 119(4): 495 - 502. [Abstract] [Full Text] [PDF]

				M. Boodhwani, F. D. Rubens, D. Wozny, and H. J. Nathan Effects of mild hypothermia and rewarming on renal function after coronary artery bypass grafting. Ann. Thorac. Surg., February 1, 2009; 87(2): 489 - 495. [Abstract] [Full Text] [PDF]

				B. G. Loef, R. H. Henning, G. Navis, A. J. Rankin, W. van Oeveren, T. Ebels, and A. H. Epema Changes in glomerular filtration rate after cardiac surgery with cardiopulmonary bypass in patients with mild preoperative renal dysfunction Br. J. Anaesth., June 1, 2008; 100(6): 759 - 764. [Abstract] [Full Text] [PDF]

				B. Mahesh, B. Yim, D. Robson, R. Pillai, C. Ratnatunga, and D. Pigott Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 370 - 376. [Abstract] [Full Text] [PDF]

				M. H. Rosner, D. Portilla, and M. D. Okusa Analytic Reviews: Cardiac Surgery as a Cause of Acute Kidney Injury: Pathogenesis and Potential Therapies J Intensive Care Med, January 1, 2008; 23(1): 3 - 18. [Abstract] [PDF]

				M. Ranucci Perioperative Renal Failure: Hypoperfusion During Cardiopulmonary Bypass? Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 265 - 268. [Abstract] [PDF]

				P. J. Van der Linden, J.-F. Hardy, A. Daper, A. Trenchant, and S. G. De Hert Cardiac surgery with cardiopulmonary bypass: does aprotinin affect outcome? Br. J. Anaesth., November 1, 2007; 99(5): 646 - 652. [Abstract] [Full Text] [PDF]

				C. Berroeta, A. Benbara, S. Provenchere, N. Ajzenberg, J. Benessiano, J.-P. Depoix, J.-M. Desmonts, B. Iung, and I. Philip A Comparison of Bilateral with Single Internal Mammary Artery Grafts on Postoperative Mediastinal Drainage and Transfusion Requirement Anesth. Analg., December 1, 2006; 103(6): 1380 - 1385. [Abstract] [Full Text] [PDF]

				J. R. Brown, R. P. Cochran, L. J. Dacey, C. S. Ross, K. S. Kunzelman, R. F. Dunton, J. H. Braxton, D. C. Charlesworth, R. A. Clough, R. E. Helm, et al. Perioperative Increases in Serum Creatinine Are Predictive of Increased 90-Day Mortality After Coronary Artery Bypass Graft Surgery Circulation, July 4, 2006; 114(1_suppl): I-409 - I-413. [Abstract] [Full Text] [PDF]

				S. Basran, R. J. Frumento, A. Cohen, S. Lee, Y. Du, E. Nishanian, H. S. Kaplan, M. Stafford-Smith, and E. Bennett-Guerrero The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery. Anesth. Analg., July 1, 2006; 103(1): 15 - 20. [Abstract] [Full Text] [PDF]

				A. Kuitunen, A. Vento, R. Suojaranta-Ylinen, and V. Pettila Acute Renal Failure After Cardiac Surgery: Evaluation of the RIFLE Classification Ann. Thorac. Surg., February 1, 2006; 81(2): 542 - 546. [Abstract] [Full Text] [PDF]

				M. H. Rosner and M. D. Okusa Acute Kidney Injury Associated with Cardiac Surgery Clin. J. Am. Soc. Nephrol., January 1, 2006; 1(1): 19 - 32. [Abstract] [Full Text] [PDF]

				M. Ranucci, F. Romitti, G. Isgro, M. Cotza, S. Brozzi, A. Boncilli, and A. Ditta Oxygen Delivery During Cardiopulmonary Bypass and Acute Renal Failure After Coronary Operations Ann. Thorac. Surg., December 1, 2005; 80(6): 2213 - 2220. [Abstract] [Full Text] [PDF]

				K. Karkouti, W.S. Beattie, D.N. Wijeysundera, V. Rao, C. Chan, K.M. Dattilo, G. Djaiani, J. Ivanov, J. Karski, and T.E. David Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 391 - 400. [Abstract] [Full Text] [PDF]

				F. Kerbaul, R. Giorgi, C. Oddoze, F. Collart, C. Guidon, P. J. Lejeune, J. Villacorta, and F. Gouin High concentrations of N-BNP are related to non-infectious severe SIRS associated with cardiovascular dysfunction occurring after off-pump coronary artery surgery Br. J. Anaesth., November 1, 2004; 93(5): 639 - 644. [Abstract] [Full Text] [PDF]

				J. Boldt, T. Brenner, J. Lang, B. Kumle, and F. Isgro Kidney-Specific Proteins in Elderly Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass Anesth. Analg., December 1, 2003; 97(6): 1582 - 1589. [Abstract] [Full Text] [PDF]