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. 2012 Jul;15(1):14-7.
doi: 10.1093/icvts/ivs106. Epub 2012 Apr 2.

The impact of major perioperative renal insult on long-term renal function and survival after cardiac surgery

Vivek Srivastava  1 , Celma D'Silva, Augustine Tang, Franco Sogliani, Dumbor L Ngaage
Affiliations

The impact of major perioperative renal insult on long-term renal function and survival after cardiac surgery

Vivek Srivastava et al. Interact Cardiovasc Thorac Surg. 2012 Jul.

Abstract

Temporary renal replacement therapy (RRT) facilitates recovery from a major perioperative renal injury and, although RRT can improve the hospital outcome, it is not known as to whether it mitigates long-term renal sequelae. Therefore, we investigated the risk of long-term dialysis after RRT post-cardiac surgery. We analysed prospectively the data collected for all hospital survivors who received RRT following cardiac surgery between March 1996 and July 2010, excluding those on dialysis preoperatively or with a functioning renal transplant. The follow-up data were obtained for all surviving patients. The mean age of the 82 patients was 68.6 ± 9.9 years, and 60 (73%) were male. Severe pre-existing renal dysfunction with a serum creatinine level of >200 μmol/l was present in 15 (18%) patients and diabetes in 31 (38%) patients. Operative procedures included redo surgery (n = 11, 13%) and thoracic aortic surgery (n = 9, 11%). During a 13.4-year follow-up, there were 38 late deaths. Only three patients with severe preoperative renal dysfunction received dialysis. The Kaplan-Meier 5- and 7-year survival rates for this patient cohort were 54% and 38%, respectively. In conclusion, a major renal insult requiring temporary RRT after cardiac surgery does not increase the risk for renal dialysis in the long term for patients with normal renal function preoperatively.

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Figures

Figure 1:
Figure 1:
A flowchart showing the selection of patients for the study and the late survival outcome.
Figure 2:
Figure 2:
A bar chart depicting the requirement of renal dialysis in patients who received renal replacement therapy after cardiac surgery at a mean follow-up of 5.2 years (range 1–13.4 years).
Figure 3:
Figure 3:
The need for renal surveillance for deteriorating the renal function in patients who had temporary renal replacement therapy after cardiac surgery at a mean follow-up of 5.2 years (range 1–13.4 years).
Figure 4:
Figure 4:
The Kaplan–Meier survival curve showing the long-term survival.
See this image and copyright information in PMC

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