Abstract: FR-PO078
Clinical Efficacy of Intraoperative Hemodialysis During Open-Heart Surgery with CKD Stage G4 and G5
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Inoue, Takahiro, Kameda Medical Center, Kamogawa, Japan
- Kuji, Hiroshi, Kameda Medical Center, Kamogawa, Japan
- Nagaoka, Kanako, Kameda Medical Center, Kamogawa, Japan
- Akanuma, Takafumi, Kameda Medical Center, Kamogawa, Japan
- Yu, Munakata, Munakata Clinic, Chiba, Japan
- Watanabe, Yoshihiko, Munakata Clinic, Chiba, Japan
- Fukuda, Junko, Kameda Medical Center, Kamogawa, Japan
- Ohara, Mamiko, Kameda Medical Center, Kamogawa, Japan
- Suzuki, Tomo, Kameda Medical Center, Kamogawa, Japan
Group or Team Name
- Department of Nephrology , Kameda Medical Center
Background
Severe acute kidney injury after cardiac surgery frequently requires renal replacement therapy (RRT) and moreover increases mortality rates and a prolonged length of hospital stay. Recently, we performed intraoperative hemodialysis (IHD) during open-heart surgery for the patients with chronic kidney disease (CKD) to prevent postoperative RRT. However, the clinical implication is unclear, therefore we investigated the efficacy of IHD.
Methods
This is a single-center cohort study with patients undergoing non-emergency cardiac surgeries between Jan, 2008 to Dec, 2018 in our hospital. The subjects were 61 patients classified as CKD G4 or G5 without chronic dialysis and post-transplant. Until Aug 2013, patients underwent surgery without IHD. Since Sep, 2013, patients were dialyzed intraoperatively. We evaluated the efficacy of IHD, comparing an IHD group (IHD) with a non IHD group (non-IHD).
Results
Comparing IHD and non-IHD, the patient number was 19 vs. 28 (CKD G4) and 9 vs. 5 (CKD G5). Preoperative eGFR (CKD G4) was 19.1±5.6 vs. 22.0±5.2 mL/min/1.73m2 (p＝0.039), and 19.1±5.6 vs. 22.0±5.2 (CKD G5). Diabetic mellitus accounted for 35.7% vs. 42.4% (P=0.384), and operative duration 331±99 vs. 295±65 min (p＝0.16). Clinical characteristics and preoperative renal function were similar between two groups. Ninety-day mortality, hospital days, duration of postoperative intubation, renal function at discharge were not significantly different between IHD and non-IHD. Regarding CKD G4, the rate of RRT within 30 days after surgery (30-day RRT) was significant lower in IHD.
Conclusion
IHD had lower incidence of 30-day RRT than non-IHD in patients with CKD G4 prior to surgery.
Clinical features and Outcome between IHD group and non IHD group
| patients undergoing cardiac surgery （N＝61) | IHD (N=28) | non IHD (N=33) | Ｐ value |
| Age,years | 74.5±7.0 | 72.9±9.4 | 0.744 |
| Male, n, % | 17(60.7) | 16（50.3） | 0.339 |
| Preoperative eGFR, G4 ml/min/1.73m2. | 22.2±3.7 | 23.8±3.2 | 0.123 |
| G5 ml/min/1.73m2 | 19.1±5.6 | 22.0±5.2 | 0.663 |
| CKDG4, n. | 19 | 28 | 0.116 |
| 90-day mortality, %. | 7.1 | 3.0 | 0.482 |
| 30-day RRT G4, n, % | 0 (0) | 7 (25.0) | 0.037 |
| G5, n, % | 5 (55.6) | 3 (60.0) | 0.933 |