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DOI: 10.1055/s-2005-862048
Intraoperative hemofiltration exhibits no clinical benefit in patients with end-stage renal failure undergoing cardiac surgery. A multicenter study
Objectives: Patients with end-stage renal disease constitute a high-risk group. Fluid-management is difficult in these patients, and intraoperative hemofiltration is often used to avoid the accumulation of extravascular water. However, whether this provides an advantage for the patients has not been studied vigorously. We therefore retrospectively analyzed the outcome among patients with and without intraoperative hemofiltration included in a large multicenter study on patients with end-stage renal failure who underwent cardiac surgery.
Material and Methods: Nine centers provided data of 518 consecutive patients (61±11 years; 30% female). Dialysis had been started a median of 3 years (3 months –26 years) before. Data on 109 preoperative and 36 intraoperative variables were collected in addition to outcome data. Multivariate analysis was used to determine the risk factors for death within 30 days after surgery.
Results: The last hemodialysis had been performed 21±8 hours before surgery. 331 patients (64%) had intraoperative hemofiltration. Overall, 57 patients (11%) died perioperatively. The use of intraoperative hemofiltration was associated with perioperative mortality in a univariate analysis (p=0.002), but the interval between last dialysis and surgery was not (p=0.18). After allowing for other pre- and intraoperative variables, intraoperative hemofiltration was no longer a associated with perioperative mortality.
Conclusions: The results of this large retrospective multicenter study challenge common practice and suggest that intraoperative hemofiltration is not beneficial to patients with end-stage renal disease undergoing cardiac surgery. The potential harm associated with intraoperative hemofiltration in the univariate analysis appears to be caused by preferential use of this technique among the sickest patients.