Acute Renal Failure Following Coronary Artery By-Pass Surgery: Perioperative Risk Factors
Mustafa Saçar, Gökhan Önem, Yaln Tolga Yaylal, İbrahim Susam, Fahri Adal, Ahmet Baltalarl
Keywords: Coronary artery bypass surgery, acute renal failure, ICU
Objective: Morbidity and mortality rates due to acute renal failure (ARF) developed in the postoperative period in patients undergoing coronary artery by-pass surgery (CABG), are increasing. After the determination of risk factors for the development of ARF in the perioperative period, treatment strategies to prevent the development of ARF can be implemented. Methods: Three hundred and nine patients who had undergone isolated CABG between May 2005 and December 2006 were included in the study. Patients' data registered in the preoperative, intra-operative, and postoperative periods were collected in the electronic media. Factors possibly affecting the development of ARF in the postoperative period were determined by univariate analysis. Later, the independent risk factors affecting the development of ARF were determined by multivariate analysis. Results: Univariate analysis showed that there was a relation between old age, low ejection fraction (EF) in the preoperative period, presence of COPD, high preoperative serum creatinine levels, long CPB duration, the requirement of intra-operative inotropic support, the amount of postoperative mediastinal drainage, peak creatinine levels, the amount of blood transfusions and postoperative ARF development. At the end of the evaluation of these factors with multivariate analysis; old age, high creatinine levels in the preoperative period, the requirement of inotropic support during the operation and increased amounts of postoperative mediastinal drainage were found to be independent risk factors for the development of ARF. Conclusions: ARF development is found to be higher in patients with old age, low EF, impaired preoperative renal functions. We suggest that implementing a close follow up with appropriate measures for these patients can decrease the risk of ARF development postoperatively.