Korean J Thorac Cardiovasc Surg.  2016 Dec;49(6):427-434. 10.5090/kjtcs.2016.49.6.427.

Results of Protocol-based Perioperative Management in Off-Pump Coronary Artery Bypass Grafting for Patients with Non-dialysis-dependent Chronic Kidney Disease

• Kim JW
• Sim HT
• Yoo JS
• Kim DJ
• Cho KR

• KMID: 2362160
• DOI: http://doi.org/10.5090/kjtcs.2016.49.6.427

Abstract

BACKGROUND
Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD.
METHODS
From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group.
RESULTS
The risk of acute kidney injury was about ×3 higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases.
CONCLUSION
Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.

Keyword

Coronary artery bypass surgery; Off-pump; Renal insufficiency, chronic; Acute kidney injury; Perioperative care

MeSH Terms

Acute Kidney Injury
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump*
Creatinine
Emergencies
Glomerular Filtration Rate
Hemodynamics
Humans
Kidney
Perioperative Care
Renal Insufficiency
Renal Insufficiency, Chronic*
Renal Replacement Therapy
Transplants*
Creatinine