Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery
This observational study sought to determine whether the degree of hemodilution during cardiopulmonary bypass is independently related to perioperative acute renal failure necessitating dialysis support. Data were prospectively collected on consecutive patients undergoing cardiac operations with car...
Gespeichert in:
| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2005-02, Vol.129 (2), p.391-400 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 400 |
|---|---|
| container_issue | 2 |
| container_start_page | 391 |
| container_title | The Journal of thoracic and cardiovascular surgery |
| container_volume | 129 |
| creator | Karkouti, K. Beattie, W.S. Wijeysundera, D.N. Rao, V. Chan, C. Dattilo, K.M. Djaiani, G. Ivanov, J. Karski, J. David, T.E. |
| description | This observational study sought to determine whether the degree of hemodilution during cardiopulmonary bypass is independently related to perioperative acute renal failure necessitating dialysis support.
Data were prospectively collected on consecutive patients undergoing cardiac operations with cardiopulmonary bypass from 1999 to 2003 at a tertiary care hospital. The independent relationship was assessed between the degree of hemodilution during cardiopulmonary bypass, as measured by nadir hematocrit concentration, and acute renal failure necessitating dialysis support. Multivariate logistic regression was used to control for variables known to be associated with perioperative renal failure and anemia.
Of the 9080 patients included in the analysis, 1.5% (n = 134) had acute renal failure necessitating dialysis support. There was an independent, nonlinear relationship between nadir hematocrit concentration during cardiopulmonary bypass and acute renal failure necessitating dialysis support. Moderate hemodilution (nadir hematocrit concentration, 21%-25%) was associated with the lowest risk of acute renal failure necessitating dialysis support; the risk increased as nadir hematocrit concentration deviated from this range in either direction (
P = .005). Compared with moderate hemodilution, the adjusted odds ratio for acute renal failure necessitating dialysis support with severe hemodilution (nadir hematocrit concentration 25%) it was 1.88 (95% confidence interval, 1.02-3.46).
Given that there is an independent association between the degree of hemodilution during cardiopulmonary bypass and perioperative acute renal failure necessitating dialysis support, patient outcomes may be improved if the nadir hematocrit concentration during cardiopulmonary bypass is kept within the identified optimal range. Randomized clinical trials, however, are needed to determine whether this is a cause-effect relationship or simply an association. |
| doi_str_mv | 10.1016/j.jtcvs.2004.06.028 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67386952</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022522304009651</els_id><sourcerecordid>67386952</sourcerecordid><originalsourceid>FETCH-LOGICAL-c530t-3f478f30f495bf7d7cfe18396de245d92819aaa93bfdedf5282813f0fca478373</originalsourceid><addsrcrecordid>eNp9kE-P1CAYh4nRuLOrn8DEcNE9tfKnpeXgYbNR12QTL5p4Iwy8zDJSWqFdM99eaifZmwcgefP8fsCD0BtKakqo-HCsj7N5zDUjpKmJqAnrn6EdJbKrRN_-fI52hDBWtYzxC3SZ85EQ0hEqX6IL2oquJy3dodMdDKP1YZn9GLFdko8HbHSyfpyWMIxRpxPenyadM_YZ64h9tDBB2eKMk8-_sNNmHhN2ZWmzzIATRB3KuLQmKDzWdgnz1qoNzks6QDq9Qi-cDhlen88r9OPzp--3d9X9ty9fb2_uK9NyMlfcNV3vOHGNbPeus51xQHsuhQXWtFaynkqtteR7Z8G6lvVlwh1xRpcg7_gVer_1Tmn8vUCe1eCzgRB0hHHJSnS8F7JlBeQbaNKYcwKnpuSH8n9FiVqNq6P6Z1ytxhURqhgvqbfn-mU_gH3KnBUX4N0Z0Nno4JKOxucnTjRCCLJy1xv34A8Pf3wClQcdQqml67WZMqmY4nIlP24kFG2PHpLKxkM0YEvKzMqO_r9P_gvi4rCX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67386952</pqid></control><display><type>article</type><title>Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Karkouti, K. ; Beattie, W.S. ; Wijeysundera, D.N. ; Rao, V. ; Chan, C. ; Dattilo, K.M. ; Djaiani, G. ; Ivanov, J. ; Karski, J. ; David, T.E.</creator><creatorcontrib>Karkouti, K. ; Beattie, W.S. ; Wijeysundera, D.N. ; Rao, V. ; Chan, C. ; Dattilo, K.M. ; Djaiani, G. ; Ivanov, J. ; Karski, J. ; David, T.E.</creatorcontrib><description>This observational study sought to determine whether the degree of hemodilution during cardiopulmonary bypass is independently related to perioperative acute renal failure necessitating dialysis support.
Data were prospectively collected on consecutive patients undergoing cardiac operations with cardiopulmonary bypass from 1999 to 2003 at a tertiary care hospital. The independent relationship was assessed between the degree of hemodilution during cardiopulmonary bypass, as measured by nadir hematocrit concentration, and acute renal failure necessitating dialysis support. Multivariate logistic regression was used to control for variables known to be associated with perioperative renal failure and anemia.
Of the 9080 patients included in the analysis, 1.5% (n = 134) had acute renal failure necessitating dialysis support. There was an independent, nonlinear relationship between nadir hematocrit concentration during cardiopulmonary bypass and acute renal failure necessitating dialysis support. Moderate hemodilution (nadir hematocrit concentration, 21%-25%) was associated with the lowest risk of acute renal failure necessitating dialysis support; the risk increased as nadir hematocrit concentration deviated from this range in either direction (
P = .005). Compared with moderate hemodilution, the adjusted odds ratio for acute renal failure necessitating dialysis support with severe hemodilution (nadir hematocrit concentration <21%) was 2.34 (95% confidence interval, 1.47-3.71), and for mild hemodilution (nadir hematocrit concentration >25%) it was 1.88 (95% confidence interval, 1.02-3.46).
Given that there is an independent association between the degree of hemodilution during cardiopulmonary bypass and perioperative acute renal failure necessitating dialysis support, patient outcomes may be improved if the nadir hematocrit concentration during cardiopulmonary bypass is kept within the identified optimal range. Randomized clinical trials, however, are needed to determine whether this is a cause-effect relationship or simply an association.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2004.06.028</identifier><identifier>PMID: 15678051</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>Philadelphia, PA: Mosby, Inc</publisher><subject>Acute Kidney Injury - epidemiology ; Acute Kidney Injury - etiology ; Acute Kidney Injury - therapy ; Adult ; Aged ; Biological and medical sciences ; Biomarkers - blood ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Female ; Hematocrit ; Hemodilution - adverse effects ; Humans ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Postoperative Complications - blood ; Postoperative Complications - etiology ; Postoperative Complications - therapy ; Renal Dialysis - adverse effects ; Renal failure ; Risk Factors ; Sensitivity and Specificity ; Severity of Illness Index ; Statistics as Topic ; Survival Analysis</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2005-02, Vol.129 (2), p.391-400</ispartof><rights>2005 The American Association for Thoracic Surgery</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c530t-3f478f30f495bf7d7cfe18396de245d92819aaa93bfdedf5282813f0fca478373</citedby><cites>FETCH-LOGICAL-c530t-3f478f30f495bf7d7cfe18396de245d92819aaa93bfdedf5282813f0fca478373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522304009651$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16466601$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15678051$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karkouti, K.</creatorcontrib><creatorcontrib>Beattie, W.S.</creatorcontrib><creatorcontrib>Wijeysundera, D.N.</creatorcontrib><creatorcontrib>Rao, V.</creatorcontrib><creatorcontrib>Chan, C.</creatorcontrib><creatorcontrib>Dattilo, K.M.</creatorcontrib><creatorcontrib>Djaiani, G.</creatorcontrib><creatorcontrib>Ivanov, J.</creatorcontrib><creatorcontrib>Karski, J.</creatorcontrib><creatorcontrib>David, T.E.</creatorcontrib><title>Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>This observational study sought to determine whether the degree of hemodilution during cardiopulmonary bypass is independently related to perioperative acute renal failure necessitating dialysis support.
Data were prospectively collected on consecutive patients undergoing cardiac operations with cardiopulmonary bypass from 1999 to 2003 at a tertiary care hospital. The independent relationship was assessed between the degree of hemodilution during cardiopulmonary bypass, as measured by nadir hematocrit concentration, and acute renal failure necessitating dialysis support. Multivariate logistic regression was used to control for variables known to be associated with perioperative renal failure and anemia.
Of the 9080 patients included in the analysis, 1.5% (n = 134) had acute renal failure necessitating dialysis support. There was an independent, nonlinear relationship between nadir hematocrit concentration during cardiopulmonary bypass and acute renal failure necessitating dialysis support. Moderate hemodilution (nadir hematocrit concentration, 21%-25%) was associated with the lowest risk of acute renal failure necessitating dialysis support; the risk increased as nadir hematocrit concentration deviated from this range in either direction (
P = .005). Compared with moderate hemodilution, the adjusted odds ratio for acute renal failure necessitating dialysis support with severe hemodilution (nadir hematocrit concentration <21%) was 2.34 (95% confidence interval, 1.47-3.71), and for mild hemodilution (nadir hematocrit concentration >25%) it was 1.88 (95% confidence interval, 1.02-3.46).
Given that there is an independent association between the degree of hemodilution during cardiopulmonary bypass and perioperative acute renal failure necessitating dialysis support, patient outcomes may be improved if the nadir hematocrit concentration during cardiopulmonary bypass is kept within the identified optimal range. Randomized clinical trials, however, are needed to determine whether this is a cause-effect relationship or simply an association.</description><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - etiology</subject><subject>Acute Kidney Injury - therapy</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Cardiac Surgical Procedures</subject><subject>Cardiopulmonary Bypass</subject><subject>Female</subject><subject>Hematocrit</subject><subject>Hemodilution - adverse effects</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Postoperative Complications - blood</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - therapy</subject><subject>Renal Dialysis - adverse effects</subject><subject>Renal failure</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><subject>Statistics as Topic</subject><subject>Survival Analysis</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE-P1CAYh4nRuLOrn8DEcNE9tfKnpeXgYbNR12QTL5p4Iwy8zDJSWqFdM99eaifZmwcgefP8fsCD0BtKakqo-HCsj7N5zDUjpKmJqAnrn6EdJbKrRN_-fI52hDBWtYzxC3SZ85EQ0hEqX6IL2oquJy3dodMdDKP1YZn9GLFdko8HbHSyfpyWMIxRpxPenyadM_YZ64h9tDBB2eKMk8-_sNNmHhN2ZWmzzIATRB3KuLQmKDzWdgnz1qoNzks6QDq9Qi-cDhlen88r9OPzp--3d9X9ty9fb2_uK9NyMlfcNV3vOHGNbPeus51xQHsuhQXWtFaynkqtteR7Z8G6lvVlwh1xRpcg7_gVer_1Tmn8vUCe1eCzgRB0hHHJSnS8F7JlBeQbaNKYcwKnpuSH8n9FiVqNq6P6Z1ytxhURqhgvqbfn-mU_gH3KnBUX4N0Z0Nno4JKOxucnTjRCCLJy1xv34A8Pf3wClQcdQqml67WZMqmY4nIlP24kFG2PHpLKxkM0YEvKzMqO_r9P_gvi4rCX</recordid><startdate>20050201</startdate><enddate>20050201</enddate><creator>Karkouti, K.</creator><creator>Beattie, W.S.</creator><creator>Wijeysundera, D.N.</creator><creator>Rao, V.</creator><creator>Chan, C.</creator><creator>Dattilo, K.M.</creator><creator>Djaiani, G.</creator><creator>Ivanov, J.</creator><creator>Karski, J.</creator><creator>David, T.E.</creator><general>Mosby, Inc</general><general>AATS/WTSA</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050201</creationdate><title>Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery</title><author>Karkouti, K. ; Beattie, W.S. ; Wijeysundera, D.N. ; Rao, V. ; Chan, C. ; Dattilo, K.M. ; Djaiani, G. ; Ivanov, J. ; Karski, J. ; David, T.E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c530t-3f478f30f495bf7d7cfe18396de245d92819aaa93bfdedf5282813f0fca478373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - etiology</topic><topic>Acute Kidney Injury - therapy</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Cardiac Surgical Procedures</topic><topic>Cardiopulmonary Bypass</topic><topic>Female</topic><topic>Hematocrit</topic><topic>Hemodilution - adverse effects</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Postoperative Complications - blood</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - therapy</topic><topic>Renal Dialysis - adverse effects</topic><topic>Renal failure</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><topic>Statistics as Topic</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karkouti, K.</creatorcontrib><creatorcontrib>Beattie, W.S.</creatorcontrib><creatorcontrib>Wijeysundera, D.N.</creatorcontrib><creatorcontrib>Rao, V.</creatorcontrib><creatorcontrib>Chan, C.</creatorcontrib><creatorcontrib>Dattilo, K.M.</creatorcontrib><creatorcontrib>Djaiani, G.</creatorcontrib><creatorcontrib>Ivanov, J.</creatorcontrib><creatorcontrib>Karski, J.</creatorcontrib><creatorcontrib>David, T.E.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karkouti, K.</au><au>Beattie, W.S.</au><au>Wijeysundera, D.N.</au><au>Rao, V.</au><au>Chan, C.</au><au>Dattilo, K.M.</au><au>Djaiani, G.</au><au>Ivanov, J.</au><au>Karski, J.</au><au>David, T.E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2005-02-01</date><risdate>2005</risdate><volume>129</volume><issue>2</issue><spage>391</spage><epage>400</epage><pages>391-400</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>This observational study sought to determine whether the degree of hemodilution during cardiopulmonary bypass is independently related to perioperative acute renal failure necessitating dialysis support.
Data were prospectively collected on consecutive patients undergoing cardiac operations with cardiopulmonary bypass from 1999 to 2003 at a tertiary care hospital. The independent relationship was assessed between the degree of hemodilution during cardiopulmonary bypass, as measured by nadir hematocrit concentration, and acute renal failure necessitating dialysis support. Multivariate logistic regression was used to control for variables known to be associated with perioperative renal failure and anemia.
Of the 9080 patients included in the analysis, 1.5% (n = 134) had acute renal failure necessitating dialysis support. There was an independent, nonlinear relationship between nadir hematocrit concentration during cardiopulmonary bypass and acute renal failure necessitating dialysis support. Moderate hemodilution (nadir hematocrit concentration, 21%-25%) was associated with the lowest risk of acute renal failure necessitating dialysis support; the risk increased as nadir hematocrit concentration deviated from this range in either direction (
P = .005). Compared with moderate hemodilution, the adjusted odds ratio for acute renal failure necessitating dialysis support with severe hemodilution (nadir hematocrit concentration <21%) was 2.34 (95% confidence interval, 1.47-3.71), and for mild hemodilution (nadir hematocrit concentration >25%) it was 1.88 (95% confidence interval, 1.02-3.46).
Given that there is an independent association between the degree of hemodilution during cardiopulmonary bypass and perioperative acute renal failure necessitating dialysis support, patient outcomes may be improved if the nadir hematocrit concentration during cardiopulmonary bypass is kept within the identified optimal range. Randomized clinical trials, however, are needed to determine whether this is a cause-effect relationship or simply an association.</abstract><cop>Philadelphia, PA</cop><pub>Mosby, Inc</pub><pmid>15678051</pmid><doi>10.1016/j.jtcvs.2004.06.028</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-5223 |
| ispartof | The Journal of thoracic and cardiovascular surgery, 2005-02, Vol.129 (2), p.391-400 |
| issn | 0022-5223 1097-685X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_67386952 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Acute Kidney Injury - epidemiology Acute Kidney Injury - etiology Acute Kidney Injury - therapy Adult Aged Biological and medical sciences Biomarkers - blood Cardiac Surgical Procedures Cardiopulmonary Bypass Female Hematocrit Hemodilution - adverse effects Humans Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Postoperative Complications - blood Postoperative Complications - etiology Postoperative Complications - therapy Renal Dialysis - adverse effects Renal failure Risk Factors Sensitivity and Specificity Severity of Illness Index Statistics as Topic Survival Analysis |
| title | Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T21%3A03%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Hemodilution%20during%20cardiopulmonary%20bypass%20is%20an%20independent%20risk%20factor%20for%20acute%20renal%20failure%20in%20adult%20cardiac%20surgery&rft.jtitle=The%20Journal%20of%20thoracic%20and%20cardiovascular%20surgery&rft.au=Karkouti,%20K.&rft.date=2005-02-01&rft.volume=129&rft.issue=2&rft.spage=391&rft.epage=400&rft.pages=391-400&rft.issn=0022-5223&rft.eissn=1097-685X&rft.coden=JTCSAQ&rft_id=info:doi/10.1016/j.jtcvs.2004.06.028&rft_dat=%3Cproquest_cross%3E67386952%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=67386952&rft_id=info:pmid/15678051&rft_els_id=S0022522304009651&rfr_iscdi=true |