Renal Failure and Replacement Therapy After Cardiac Surgery

Abstract

We read with interest the article by Filsoufi et al1Filsoufi F. Rahmanian P.B. Castillo J.G. et al.Predictors and early and late outcomes of dialysis-dependent patients in contemporary cardiac surgery.J Cardiothorac Vasc Anesth. 2008; 22: 522-529Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar about outcomes and predictors of renal failure in 6,449 cardiac surgical patients, reporting a mortality of 36.7% among patients with renal failure requiring dialysis (RF-D). We recently published an article on the same subject2Landoni G. Zangrillo A. Franco A. et al.Long-term outcome of patients who require renal replacement therapy after cardiac surgery.Eur J Anaesthesiol. 2006; 23: 17-22Crossref PubMed Scopus (50) Google Scholar and, analyzing an equally large number of patients (n = 7,846), described a slightly reduced hospital mortality in the overall population (2.57% v 3.58%) together with an increased hospital mortality in the subset of patients receiving RF-D (66.7% v 36.7%). The explanation for such discrepancy could be identified in the different serum creatinine threshold used to identify RF-D, which probably caused the selection of a larger group of patients with RF-D (1.6% v 2.2%) with a lower risk profile in the Filsoufi et al article. Also, they reported a lower long-term survival rate (48.5% after 1 year) than we did (71.4% after 42 months). Both studies underlined the importance of preoperative renal failure, hemodynamic instability, and reoperation in predicting RF-D, whereas other predictors were identified only by one of the studies; in particular, Filsoufi et al1Filsoufi F. Rahmanian P.B. Castillo J.G. et al.Predictors and early and late outcomes of dialysis-dependent patients in contemporary cardiac surgery.J Cardiothorac Vasc Anesth. 2008; 22: 522-529Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar indicated diabetes as being an independent predictor of mortality, whereas we found it had no statistical significance. In conclusion, there is still a need for studies on RF-D after cardiac surgery because of its high mortality and morbidity1Filsoufi F. Rahmanian P.B. Castillo J.G. et al.Predictors and early and late outcomes of dialysis-dependent patients in contemporary cardiac surgery.J Cardiothorac Vasc Anesth. 2008; 22: 522-529Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 2Landoni G. Zangrillo A. Franco A. et al.Long-term outcome of patients who require renal replacement therapy after cardiac surgery.Eur J Anaesthesiol. 2006; 23: 17-22Crossref PubMed Scopus (50) Google Scholar, 3Landoni G. Bove T. Crivellari M. et al.Acute renal failure after isolated CABG surgery: Six years of experience.Minerva Anestesiol. 2007; 73: 559-565PubMed Google Scholar, 4Heringlake M. Knappe M. Vargas Hein O. et al.Renal dysfunction according to the ADQI-RIFLE system and clinical practice patterns after cardiac surgery in Germany.Minerva Anestesiol. 2006; 72: 645-654PubMed Google Scholar and the lack of a precise, universally used definition1Filsoufi F. Rahmanian P.B. Castillo J.G. et al.Predictors and early and late outcomes of dialysis-dependent patients in contemporary cardiac surgery.J Cardiothorac Vasc Anesth. 2008; 22: 522-529Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 2Landoni G. Zangrillo A. Franco A. et al.Long-term outcome of patients who require renal replacement therapy after cardiac surgery.Eur J Anaesthesiol. 2006; 23: 17-22Crossref PubMed Scopus (50) Google Scholar, 3Landoni G. Bove T. Crivellari M. et al.Acute renal failure after isolated CABG surgery: Six years of experience.Minerva Anestesiol. 2007; 73: 559-565PubMed Google Scholar, 4Heringlake M. Knappe M. Vargas Hein O. et al.Renal dysfunction according to the ADQI-RIFLE system and clinical practice patterns after cardiac surgery in Germany.Minerva Anestesiol. 2006; 72: 645-654PubMed Google Scholar, 5Boldt J. Wolf M. Identification of renal injury in cardiac surgery: The role of kidney-specific proteins.J Cardiothorac Vasc Anesth. 2008; 22: 122-132Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar and treatment.6Landoni G. Biondi-Zoccai G.G. Marino G. et al.Fenoldopam reduces the need for renal replacement therapy and in-hospital death in cardiovascular surgery: A meta-analysis.J Cardiothorac Vasc Anesth. 2008; 22: 27-33Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar, 7Zarbock A. Singbartl K. Kellum J.A. Evidence-based renal replacement therapy for acute kidney injury.Minerva Anestesiol. 2008 May 15; ([Epub ahead of print])PubMed Google Scholar Furthermore, although some of its predictors have been identified and proven, others still need to be thoroughly investigated. Predictors and Early and Late Outcomes of Dialysis-Dependent Patients in Contemporary Cardiac SurgeryJournal of Cardiothoracic and Vascular AnesthesiaVol. 22Issue 4PreviewObjectives: The aim of the study was to investigate the incidence and predictors of renal failure requiring dialysis (RF-D) in a contemporary cohort of patients undergoing cardiac surgery. The authors also analyzed early and late outcome of patients with this complication.Design: A retrospective study of consecutive patients undergoing cardiac surgery using a computerized database based on the New York State Department of Health registry. Data collection was performed prospectively.Setting: A university hospital (single institution). Full-Text PDF