• Tiziana Bove, Maria Grazia Calabrò, Giovanni Landoni, Giacomo Aletti, Giovanni Marino, Giuseppe Crescenzi, Concetta Rosica, and Alberto Zangrillo.
• Department of Cardiovascular Anesthesia, Vita-Salute University-IRCCS San Raffaele Hospital, via Olgettina (degree)60 20132 Milano, Italy. bove.tiziana@hsr.it
• J. Cardiothorac. Vasc. Anesth. 2004 Aug 1; 18 (4): 442-5.

ObjectiveTo evaluate outcome and risk factors of acute renal failure in a surgical population with or without preoperative renal dysfunction.DesignObservational study.SettingIntensive care unit at a University Hospital.ParticipantsFive thousand sixty-eight consecutive adult patients who underwent cardiac surgery with cardiopulmonary bypass.InterventionsPerioperative variables measured were age, sex, basic pathology, preoperative renal impairment defined as creatinine >1.4 mg/dL, ventricular dysfunction, preoperative neurologic event, chronic obstructive pulmonary disease, diabetes, type of surgery, use of intra-aortic balloon pump (IABP), cardiopulmonary bypass (CPB) duration, redo or emergency surgery, hemorrhage, blood transfusion, surgical revisions, and postoperative complications.Measurements And Main ResultsAcute renal failure (100% creatinine increase) developed in 171 (3.4%) patients, whereas 94 patients (1.9% of the population) had renal replacement therapy. Hospital mortality was 40.9% in patients with acute renal failure and increased to 63.8% when renal replacement therapy was requested. Sex, age, emergency surgery, low ejection fraction, IABP device, redo, diabetes, mitral valve surgery, CPB duration, and preoperative renal disease were independently associated with acute renal failure at a multivariate analysis.ConclusionThis study confirms that acute renal failure is one of the major complications of cardiac surgery, identifies the risk factors, and suggests that optimizing cardiac output and reducing CPB time could improve the outcome of patients at high risk of acute renal failure.

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