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The Journal of Thoracic and Cardiovascular Surgery, Vol 71, 323-333, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RM Abel, MJ Buckley, WG Austen, GO Barnett, CH Beck Jr and JE Fischer
A prospective study of 500 consecutive patients surviving the first 24
hours following cardiac surgical procedures was undertaken to determine the
prevalence, etiology and results of therapy for postoperative acute renal
failure (ARF). Thirty-five patients developed either moderate or severe ARF
and an additional 102 developed mild preprenal azotemia. Positive risk
factors noted inthe development of postoperative renal failure included
age, elevated preoperative concentrations of blood urea nitrogen (BUN),
serum creatinine, and decreased 24 hour urine creatinine clearance. The
duration of cardiopulmonary bypass (CPB), aortic cross-clamping, and the
total duration of the operation also closely correlated with the incidence
of ARF. In the early postoperative period, clinical assessment of
hemodynamic change was most helpful in predicting postoperative ARF.
Significant negative risk factors included type of operation performed, New
York Heart Association classification, the use of preoperative diuretic
therapy, and associated other chronic illnesses. During the operation
itself, the lowest and mean blood pressures, flow rates on CPB and the
presence of hemoglobinuria failed to correlate with subsequent ARF. The
mortality rate for established ARF was extremely poor (88.8 per cent), and
there were no survivors among those requiring dialysis. ARF following
cardiac surgery is a highly lethal complication which arises in a setting
of inadequate cardiac function and is associated with a multiple organ
system failure. Therapy of this postoperative complication, therefore,
appears to be better directed toward its prevention rather than treatment
once established.
ARTICLES
Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients
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