All issues > Volume 35(9); 1992

Original Article

J Korean Pediatr Soc. 1992;35(9):1198-1209. Published online September 15, 1992.

Acute Renal Failure Following Cardiac Surgery

Kang Yong KY Park¹, Yeon Ho YH Choi¹, Tae Sun TS Ha¹, Il Soo IS Ha¹, Hae Il HI Cheong¹, Yong Y Choi¹, Kwang Wook KW Ko¹, Joon Ryang JR Rho²

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
²Department of Thoracic Surgery, Seoul National University College of Medicine, Seoul, Korea

Abstract

A retrospective study of 452 patients who undertook cardiac surgery was performed to determine the pevalence, etiology, and clinical features of postoperative acute renal failure(ARF). The overall incidence of ARF following cardiac surgery was 4.65%(21/452). The incidence of ARF following open heart surgery(OHS) was 5.11%, and that following closed heart surgery was 2.50%. Preoperactive risk factors noted in the development of postoperative ARF were cyanosis, age younger than 1 month, and hypotension. Intraoperative risk factors were as follows : arrhythmia, cardiopulmonary bypass(CPB)time longer than 150minutes, corses clamping time of aorta longer than 60 minutes, and circulatory arrest. Postoperative risk factors in the development of postoperative ARF were hypotension, arrhythmia, and sepsis or disseminated intravascular coagulation. ARF following cardiac surgery was usually diagnosed in 8 hours after operation, and the remainder within 48 hours. ARF following cardiac surgery was usually diagnosed in 8 hours after operation, and the remainder within 48 hours. ARF follwing cardiac surgery was manifested as oliguria or anuria for 1 to 6 days, in 57.1%, hyperkalemia in 9.5%, hyponatremia in 14.3%, and acidosis (pH<7.2) in 9.5% respectively. Peritoneal dialysis was performed in 3 patients. In a patient sepsis developed secondary to peritonitis, from whom the catheter was removed on the 5th dialysis day. All of the 3 patients died despited peritoneal dialysis. In addition to univariate analysis, multivariate analysis was done to investigate tultifactorial nature of ARF following cardiac surgery. Linear logistic regression analysis revealed that among 120 possible logit-models, the logit-model with 3 explanatory variables such as age younger than 1 month, CPB time longer than 150 minutes, and cross clamping time of aorta longer than 60 minuteds showed a good fit. In conclusion, it is possible to say that the pathogenesis of ARF following cardiac surgery is multifactorial and that there is a high risk(93.3%) of ARF following cardiac surgery with the 3 factors of age younger than month, CPB time longer than 150 minutes, and cross clamping time of aorta longer than 60 minutes. Therefore urine output and renal function should be closely minitored in these high risk patients and eforst to restore renal function, including peritoneal dialysis, must be tried as soon as renal dysfunction is detected.

Keywords :Acute renal failure, Cardiac surgery