Original article: cardiovascularThe association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery
Section snippets
Population selection
After Institutional Review Board approval (Duke University Medical Center IRB registry #3048-01-8R0ER, approved on August 3, 2001), demographic and outcome data were obtained from the Duke Cardiothoracic Surgery Database for all primary elective coronary artery bypass graft surgeries performed at Duke University Medical Center between February 1995 and February 1997. Patients with concomitant open chamber procedures and preoperative renal failure requiring dialysis were excluded from selection.
Results
A total of 1,404 patients undergoing primary elective CABG surgery met the criteria for analysis. Their demographic profile (Table 1) was similar to that of other previously reported populations [4]. Hematocrit, hemodynamic, and creatinine data are shown in Table 2. Among the excluded patients, 6 died within 48 hours of surgery, 7 were receiving preoperative dialysis, and 5 patients had acute renal failure requiring renal replacement therapy within 10 days of surgery.
In the primary
Comment
We found a significant association between lowest hematocrit during bypass and creatinine rise after coronary bypass surgery that is influenced by body weight. The degree to which lowest hematocrit during bypass is adversely related to postoperative creatinine rise is proportional to increasing body weight (Fig 1). The following example illustrates this finding. In a 75-kg patient there is no association between lowest hematocrit during bypass and postoperative creatinine rise. However in a
Acknowledgements
This work was supported by the Cardiothoracic Division of the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina. The authors would like to gratefully acknowledge the contribution of Christopher Keith, and Cheryl Stetson, Department of Anesthesiology, Duke University Medical Center, in the preparation of this manuscript.
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