Changes in glomerular filtration rate after cardiac surgery with cardiopulmonary bypass in patients with mild preoperative renal dysfunction

• Published in: British journal of anaesthesia : BJA Vol. 100; no. 6; pp. 759 - 764
• Main Authors: Loef, B.G., Henning, R.H., Navis, G., Rankin, A.J., van Oeveren, W., Ebels, T., Epema, A.H.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.06.2008; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Cardiac Surgical Procedures - adverse effects; cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; complications; complications, renal; Creatinine - blood; Female; function; Glomerular Filtration Rate; heart; heart, cardiopulmonary bypass; Humans; Iodine Radioisotopes; Iothalamic Acid; kidney; Kidney - physiopathology; kidney, function; Male; Medical sciences; Middle Aged; Postoperative Period; Prospective Studies; renal; Renal Insufficiency - complications; Renal Insufficiency - physiopathology; Renal Plasma Flow; complications, renal; kidney, function; heart, cardiopulmonary bypass; Cardiopulmonary bypass; Human; cardiopulmonary bypass; kidney; Glomerular filtration; complications; Surgery; function; Anesthesia; Complication; Preoperative; renal; heart
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aen081

Cardiac surgery with cardiopulmonary bypass (CPB) is commonly perceived as a risk factor for decline in renal function, especially in patients with preoperative renal dysfunction. There are few data on the effects of CPB on renal function in patients with mild preoperative renal dysfunction. The purpose of this study was to evaluate renal function in patients with pre-existing mild renal dysfunction undergoing cardiac surgery with CPB. In a multicentre study cohort we measured prospectively the glomerular filtration rate (GFR) by radioactive markers both before operation and on the 7th postoperative day in cardiac surgical patients with preoperative serum creatinine >120 μmol l−1 (n=56). In a subgroup of patients (n=14) in addition to the GFR, the effective renal plasma flow (ERPF) and the filtration fraction (FF) were measured. While preoperative GFR [77.9 (25.5) ml min−1] increased to 84.4 (23.7) ml min−1 (P=0.005) 1 week after surgery, ERPF did not change [295.8 (75.2) ml min−1 and 295.9 (75.9) ml min−1, respectively; P=0.8]. In accordance, the FF increased from 0.27 (0.05) (before operation) to 0.30 (0.04) (Day 7, P=0.01). Our results oppose the view that cardiac surgery with CPB adversely affects renal function in patients with preoperative mild renal dysfunction and an uncomplicated clinical course.