Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Results of Protocol-based Perioperative Management in Off-Pump Coronary Artery Bypass Grafting for Patients with Non-dialysis-dependent Chronic Kidney Disease

  • Kim, Jeong-Won (Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital) ;
  • Sim, Hyung Tae (Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital) ;
  • Yoo, Jae Suk (Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital) ;
  • Kim, Dong Jin (Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital) ;
  • Cho, Kwang Ree (Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital)
  • Received : 2015.12.22
  • Accepted : 2016.03.02
  • Published : 2016.12.05
Download PDF
⟨ Previous Next ⟩

Abstract

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 ${\times}3$ 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.

Keywords

References

  1. Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003;108:2154-69. https://doi.org/10.1161/01.CIR.0000095676.90936.80
  2. Devbhandari MP, Duncan AJ, Grayson AD, et al. Effect of risk-adjusted, non-dialysis-dependent renal dysfunction on mortality and morbidity following coronary artery bypass surgery: a multi-centre study. Eur J Cardiothorac Surg 2006;29:964-70. https://doi.org/10.1016/j.ejcts.2006.03.038
  3. Cooper WA, O'Brien SM, Thourani VH, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 2006;113:1063-70. https://doi.org/10.1161/CIRCULATIONAHA.105.580084
  4. Boulton BJ, Kilgo P, Guyton RA, et al. Impact of preoperative renal dysfunction in patients undergoing off-pump versus on-pump coronary artery bypass. Ann Thorac Surg 2011;92:595-601. https://doi.org/10.1016/j.athoracsur.2011.04.023
  5. Kim MY, Jang HR, Huh W, et al. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Ren Fail 2011;33:316-22. https://doi.org/10.3109/0886022X.2011.560406
  6. Garg AX, Devereaux PJ, Yusuf S, et al. Kidney function after off-pump or on-pump coronary artery bypass graft surgery: a randomized clinical trial. JAMA 2014;311:2191-8. https://doi.org/10.1001/jama.2014.4952
  7. Seabra VF, Alobaidi S, Balk EM, Poon AH, Jaber BL. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol 2010;5:1734-44. https://doi.org/10.2215/CJN.02800310
  8. Abu-Omar Y, Taghavi FJ, Navaratnarajah M, et al. The impact of off-pump coronary artery bypass surgery on postoperative renal function. Perfusion 2012;27:127-31. https://doi.org/10.1177/0267659111429890
  9. Tabata M, Takanashi S, Fukui T, et al. Off-pump coronary artery bypass grafting in patients with renal dysfunction. Ann Thorac Surg 2004;78:2044-9. https://doi.org/10.1016/j.athoracsur.2004.06.040
  10. Sajja LR, Mannam G, Chakravarthi RM, et al. Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency: a randomized study. J Thorac Cardiovasc Surg 2007;133:378-88. https://doi.org/10.1016/j.jtcvs.2006.09.028
  11. Levey AS, Coresh J. Chronic kidney disease. Lancet 2012;379:165-80. https://doi.org/10.1016/S0140-6736(11)60178-5
  12. Andrassy KM. Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'. Kidney Int 2013;84:622-3.
  13. Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients?: a meta-analytic study. Crit Care Med 2009;37:2079-90. https://doi.org/10.1097/CCM.0b013e3181a00a43
  14. Kidney Disease Outcomes Quality Initiative. KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl 2012;2:1-138. https://doi.org/10.1038/kisup.2012.1
  15. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47. https://doi.org/10.7326/0003-4819-139-2-200307150-00013
  16. Sajja LR, Mannam G, Chakravarthi RM, Guttikonda J, Sompalli S, Bloomstone J. Impact of preoperative renal dysfunction on outcomes of off-pump coronary artery bypass grafting. Ann Thorac Surg 2011;92:2161-7. https://doi.org/10.1016/j.athoracsur.2011.05.015
  17. Hillis GS, Croal BL, Buchan KG, et al. Renal function and outcome from coronary artery bypass grafting: impact on mortality after a 2.3-year follow-up. Circulation 2006;113:1056-62. https://doi.org/10.1161/CIRCULATIONAHA.105.591990
  18. Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009;119:495-502. https://doi.org/10.1161/CIRCULATIONAHA.108.786913
  19. Di Mauro M, Gagliardi M, Iaco AL, et al. Does off-pump coronary surgery reduce postoperative acute renal failure?: the importance of preoperative renal function. Ann Thorac Surg 2007;84:1496-502. https://doi.org/10.1016/j.athoracsur.2007.05.054
  20. Alsabbagh MM, Asmar A, Ejaz NI, Aiyer RK, Kambhampati G, Ejaz AA. Update on clinical trials for the prevention of acute kidney injury in patients undergoing cardiac surgery. Am J Surg 2013;206:86-95. https://doi.org/10.1016/j.amjsurg.2012.08.007