| Acute Renal Failure Following Cardiac Surgery |
|
Kang Yong Park1, Yeon Ho Choi1, Tae Sun Ha1, Il Soo Ha1, Hae Il Cheong1, Yong Choi1, Kwang Wook Ko1, Joon Ryang Rho2 |
1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
2Department of Thoracic Surgery, Seoul National University College of Medicine, Seoul, Korea |
| 심장 수술후에 속발한 급성 신부전 |
|
박강용1, 최연호1, 하태선1, 하일수1, 정해일1, 최용1, 고광욱1, 노준량2 |
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 흉부외과학교실 |
|
|
|
|
| Abstract |
|
A retrospective study of 452 patients who undertook cardiac surgery was performed to determine the pevalence, etiology, and clinical features of postoperative acute renal failure(ARF). The overall incidence of ARF following cardiac surgery was 4.65%(21/452). The incidence of ARF following open heart surgery(OHS) was 5.11%, and that following closed heart surgery was 2.50%. Preoperactive risk factors noted in the development of postoperative ARF were cyanosis, age younger than 1 month, and hypotension. Intraoperative risk factors were as follows : arrhythmia, cardiopulmonary bypass(CPB)time longer than 150minutes, corses clamping time of aorta longer than 60 minutes, and circulatory arrest. Postoperative risk factors in the development of postoperative ARF were hypotension, arrhythmia, and sepsis or disseminated intravascular coagulation.
ARF following cardiac surgery was usually diagnosed in 8 hours after operation, and the remainder within 48 hours. ARF following cardiac surgery was usually diagnosed in 8 hours after operation, and the remainder within 48 hours. ARF follwing cardiac surgery was manifested as oliguria or anuria for 1 to 6 days, in 57.1%, hyperkalemia in 9.5%, hyponatremia in 14.3%, and acidosis (pH<7.2) in 9.5% respectively. Peritoneal dialysis was performed in 3 patients. In a patient sepsis developed secondary to peritonitis, from whom the catheter was removed on the 5th dialysis day. All of the 3 patients died despited peritoneal dialysis.
In addition to univariate analysis, multivariate analysis was done to investigate tultifactorial nature of ARF following cardiac surgery. Linear logistic regression analysis revealed that among 120 possible logit-models, the logit-model with 3 explanatory variables such as age younger than 1 month, CPB time longer than 150 minutes, and cross clamping time of aorta longer than 60 minuteds showed a good fit.
In conclusion, it is possible to say that the pathogenesis of ARF following cardiac surgery is multifactorial and that there is a high risk(93.3%) of ARF following cardiac surgery with the 3 factors of age younger than month, CPB time longer than 150 minutes, and cross clamping time of aorta longer than 60 minutes. Therefore urine output and renal function should be closely minitored in these high risk patients and eforst to restore renal function, including peritoneal dialysis, must be tried as soon as renal dysfunction is detected. |
| Key Words:
Acute renal failure, Cardiac surgery |
|
PDF Links
Download Citation
