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Long-term outcome of patients who require renal replacement therapy after cardiac surgery

Published online by Cambridge University Press:  23 December 2005

G. Landoni ,
A. Zangrillo ,
A. Franco ,
G. Aletti ,
A. Roberti ,
M. G. Calabrò ,
G. Slaviero ,
E. Bignami  and
G. Marino
G. Landoni
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
A. Zangrillo
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
A. Franco
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
G. Aletti
Affiliation:
Università degli Studi di Milano, Department of Mathematics, Milano, Italy
A. Roberti
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
M. G. Calabrò
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
G. Slaviero
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Nephrology, Milano, Italy
E. Bignami
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
G. Marino
Affiliation:
Università Vita-Salute di Milano, IRCCS San Raffaele Hospital, Department of Cardiovascular Anaesthesia and Intensive Care, Milano, Italy
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Summary

Background and objective: Acute renal failure is a serious complication of cardiac surgery. We studied the long-term survival and quality of life of patients requiring renal replacement therapy after cardiac surgery, since they represent a heavy burden on hospital resources and their outcome has never been adequately evaluated. Methods: Out of 7846 consecutive cardiac surgical patients, 126 (1.6%) required postoperative renal replacement therapy: their preoperative status and hospital course was compared with patients who had no need of postoperative renal replacement therapy. A multivariate analysis identified predictors of renal replacement therapy. Long-term survival and quality of life was collected in patients who had renal replacement therapy and in case-matched controls. Results: Hospital mortality in the study group was 84/126 (66.7%) vs. 118/7720 (1.5%) in the control population (P < 0.001). Patients who underwent renal replacement therapy and were discharged from the hospital (42 patients) had a reasonable long-term outcome: at 42 ± 23 months, 30 out of 42 patients were alive, with only 3 patients complaining of limitations in daily activities. Predictors of in-hospital renal replacement therapy were: emergency surgery, preoperative renal impairment, intra-aortic balloon pumping, reoperation for bleeding, previous cardiac surgery, female gender, low ejection fraction, bleeding >1000 mL, chronic obstructive pulmonary disease and age. Conclusions: This study confirms that the in-hospital mortality of patients requiring renal replacement therapy is high and shows a low long-term mortality with reasonable quality of life in patients discharged from hospital alive.

Keywords

KIDNEY FAILURE ACUTERENAL REPLACEMENT THERAPYCARDIAC SURGICAL PROCEDURESMORTALITYHOSPITAL MORTALITY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 1 , January 2006 , pp. 17 - 22
Copyright
© 2006 European Society of Anaesthesiology

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