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DOI: 10.1055/s-0029-1246729
Different dialysis techniques have no influence on outcome in patients who develop dialysis dependent renal failure following cardiac surgery
Objectives: The onset of dialysis-dependent renal failure (RF-D) following cardiac surgery is associated with an adverse outcome and prolonged hospitalization. Furthermore, there is a controversy regarding the optimal dialysis technique (continuous veno-venous hemofiltration and hemodiafiltration, CVVH/CVVHDF; intermittent hemodialysis, HD; slow extended daily dialysis, SLED) in this special patient collective. In our institution we recently switched the technique from CVVH/CVVHDF to HD/SLED. Therefore we had the opportunity to determine the impact of these different approaches on outcome in a contemporary cohort of cardiac surgery patients.
Methods: We retrospectively analyzed 98 patients (mean age 73±10 years, 59% male) who required dialysis following cardiac surgery at our institution between 10/2007 and 06/2009. CVVH/CVVHDF (Group1) was applied in 41 (42%) patients whereas 57 (58%) patients underwent HD/SLED (Group2). The main outcome parameters investigated were hospital mortality, major complications and length of stay (LOS).
Results: Hospital mortality following RF-D was 37.8% (n=37) and not significantly different between groups (Group1: 46%; n=19 vs. Group2: 32%; n=18; p=0.147). Complications included sepsis (Group1: 37%; n=15; Group2: 32%; n=18; p=0.667), gastrointestinal complications (Group1: 29%; n=12; Group2: 21%; n=12; p=0.476), stroke (Group1: 12%; n=5; Group2: 19%; n=11; p=0.415), and wound infection (Group1: 10%; n=4; Group2: 16%; n=9; p=0.548) and were not different between the groups. Duration of mechanical ventilation (223±246 vs. 232±293 hours; p=0.876) and LOS (17±13 vs. 21±18 days; p=0.261) were equal between both groups.
Conclusions: Renal failure requiring dialysis remains a devastating complication. The dialysis technique does not seem to impact outcome. The poor survival of patients with RF-D, however, underlines the need to direct more resources towards prevention and treatment of this complication in cardiac surgery patients.