Perioperative Management Of Renal Disfunction And Acute Renal Failure In Adult Patient Undergoing Cardiac Surgery

Acute renal failure(ARF) remains a frequent and serious complications of cardiac surgery, the incidence of ARF following cardiac surgery has been reported to vary between 4% to 15%, half of them needed for haemodialysis support, it is associated with a 50% mortility. Despite of steady improvements in perioperative care and early haemodialysis support, therehas not been a trend in decreasing morbidity and mortility. Theaetiology of ARF following cardiac surgery is still poorlyunderstood. Treatment of acute renal failure supported by haemodialysis requires careful management of fluid balance, avoidance of nephrotoxic drugs, reduction in doses of drugs cleared or excreted by the kidneys, measurements of blood concentrations of potentially toxic drugs, and prevention of infection and other complications, and waiting for the recovery of renal function, and at meaning time, preoperative renal disfunction is a major determinant of postoperative morbidity and mortility, even mild increase in serum creatinine preoperative showed a significantly higher morbidity and mortality rate than those without renal complications beforeoperation, so, active and close measures should be taken perioperatively to prevent those patients from acute renal failure after cardiac surgery. Now, in the ICU of advanced country, instead of the peritoneal dialysis (PD), the Continuous Renal Replacement Therapy(CRRT) has been the main measurement to support the kidney, but in our country, PD is still widely used in the cardiothoracic intensive care unit(CTICU), and there is no report about CRRT treating severe ARF after cardiac operation, the report of perioperative care in patients undergoing cardiac surgery with preoperative renal insufficiency is also less. The object of our study is to retrospective evaluate the effect of peritoneal dialysis (PD) for acute renal failure (ARF) following cardiac surgery in adult, and to exchange the initial experience of CRRT in our CTICU to treat adult patient with severe ARF following cardiac surgery, and To discuss the perioperative care in patients undergoing cardiac surgery with preoperative renal insufficiency.The objective in the first part of our study is to To evaluate the effect of peritoneal dialysis (PD) for acute renal failure (ARF) following cardiac surgery in adult; Retrospective data on 147 consecutive adult patients with ARF following cardiac surgery from February 1, 1998 to December 31, 2002 wereanalyzed, 98 of them needed PD. General indications for PD were: hypervolemia, hyperkalemia, progressive acidosis, progressive uremia or rise in serum creatinine of greater than 176. 8 u mol/L. The dialysis catheter(Tenckhoff catheter) is placed by surgical cutdown just below the umbilicus and positioned in pelvis. Exchange were performed using the 1. 5% dextrose lactate peritoneal dialysis solution(made in Treefull Medical CO. LTD. Shanghai, China), routinely adding heparin 3mg and Cefradine 0. 5g in every 1000ml solution, using 10ml to 20ml 50% dextrose to vary glucose concentration to remove more or less volume and solute, dwelling for more than 45min. 2655 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass from February 1, 1998 to December 31, 2002, the morbidity of ARF is 5. 54%, ARF requiring PD occurs in 66. 67%, the morbidity of ARF needed dialysis is 3.66%. With 5~30 days PD, 48 cases survival, 51 cases death, the mortality is 51.02%. most of them die of continuous low cardiac output and following multiple organs failure. So, PD is a effective method to treat ARF following cardiac surgery in adult patients in our country, and should be start as early as possible.The objective of the second part is to exchange the initial experience of CRRT in our CTICU to treat 13 adult patients withsevere ARF following cardiac surgery. All those patients were treated with Diapact CRRT machine (Braun, Irvine, CA) ; Mode: 2 case in CVVH, and the others in CVVHFD ; Priming solution: 0.9%NaCl 2 L with heparin 5000 units/L; Blood flow rate: 100ml/min to 150ml/min; Dialy...