Horizon Information Portal

MSOE Library Home

MSOE Library Home

Home

The determination of the effects of intra-operative hemoconcentration on renal function / by Jennifer L. Schmidt.

by Schmidt, Jennifer L.

Cardiovascular system -- Diseases -- Treatment

Acute renal failure.

Cardiopulmonary bypass -- Adverse effects

Hemodialysis -- complications.

vi, Pagination varies : ill. ; 28 cm.

Committee members: Dr. Ronald Gerrits, Dr. Charles Tritt, Dr. Larry Fennigkoh.

Introduction -- Problem -- Background -- Purpose -- Hypotheses -- Materials and Methods -- Results -- Discussion -- Conclusion -- Appendices A- Instructions for authors B- Institutional review and patient informed consent documents C- Raw data tables.

Background. Hemoconcentration is a technique that has been used during cardiac surgery in conjunction with cardiopulmonary bypass (CPB) since the mid-1970's. It is commonly used as a means of reducing the hemodilution that occurs as a result of CPB priming solutions and other intra-operative drug and fluid administration. While there are few stated risks or contraindications associated with its use, there has been recent concern that hemoconcentration may contribute to peri- and post-operative renal dysfunction.

Purpose. This study was undertaken to determine whether or not heomconcentration is a risk factor for the development of renal dysfunction.

Methods. A prospective study on 40 patients undergoing cardiac surgery with the use of CPB was performed. Patients were assigned to either the hemoconcentration or the control group based on their individual intra-operative needs. CPB and anesthetic technique were standardized for all patients. Renal function was determined by intera-operative analysis of serum creatinine concentrations and urinary creatinine clearances: and post-operative analysis of serum creatinine and BUN concentrations. The incidences of acute renal insufficiency (ARI), characterized by serum creatinine concentrations of 1.6-2.4 mg/dL, and acute renal failure (ARF) characterized by serum creatinine concentrations ≥ 2.5 mg/dL were recorded. The endpoints for data collection were death, the need for dialysis, and length of hospital stay.

Results. Patients in the hemoconcentration group experienced significantly elevated serum creatinine concentrations at all time intervals post-operatively, as well as significantly elevated BUN concentrations on post-operative day five in comparison to the control group.This finding was, however, complicated by the fact that the two groups differed significantly with regard to serum creatinine prior to treatment. However, the hemoconcentration group did experience a greater percentage increase in both serum creatinine and BUN concentrations post-operatively and was the only group to expereince serum creatinine concentrations outside of the nromal range. The hemoconcentration group also experienced a significantly more rapid increase in serum creatinine concentrations post-operatively. Furthermore, the hemoconcentration group had a higher incidence of both ARI and ARF post-operatively, with two of the patients requiring dialysis. Renal dysfunction was more common in patients with pre-operative renal dysfuntion and those undergoing asurgery involving redo sternotomy.

Conclusions. The data confirms that the hemoconcentration group had a greater tendency to develop renal dysfunction post-operatively. However, this study cannot conclusively confirm that hemoconcentration was the sole contributor to the renal dysfunction seen in the treatment group because the two groups differed pre-operatively with regard to serum creatinine, thereby calling into question their renal condition prior to treatment. Further investigation with a larger patient sample size is warranted for conclusive determination of the effects of hemoconcentraion on renal function.

Horizon Information Portal 3.25_9885

Powered by SirsiDynix

© 2001-2013 SirsiDynix All rights reserved.

Horizon Information Portal