Results of Protocol-based Perioperative Management in Off-Pump Coronary Artery Bypass Grafting for Patients with Non-dialysis-dependent Chronic Kidney Disease
Background: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pum...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Thoracic and Cardiovascular Surgery
2016-12-01
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| Series: | Korean Journal of Thoracic and Cardiovascular Surgery |
| Subjects: | |
| Online Access: | http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2016.49.6.427 |
| Summary: | Background: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the
on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney
injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass
grafting, we adopted protocol-based perioperative management for patients with CKD. Methods: From
December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting.
To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure
and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function
(normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate
hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the
protocol for the CKD group. Results: The risk of acute kidney injury was about ×3 higher in the CKD group
than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated
until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative
management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day
without requiring renal replacement therapy in all cases. Conclusion: Off-pump coronary bypass surgery combined
with this protocol-based perioperative management strategy in patients with non-dialysis-dependent
CKD could mostly be performed without renal replacement therapy. |
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| ISSN: | 2233-601X 2093-6516 |