Skip to main content

Advertisement

SpringerLink
Log in

Can postoperative renal dysfunction be predicted by measuring intraoperative glomerular filtration rate in patients undergoing coronary artery bypass grafting without cardiopulmonary bypass? A pilot study

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

Currently, there is no effective paradigm to identify patients who are at risk for renal dysfunction following cardiac surgery. The specific mechanisms of renal injury during surgery are incompletely understood. The aim of the study was to evaluate whether postoperative renal dysfunction can be predicted from intraoperative glomerular filtration rate (GFR).

Design

This is a prospective study.

Setting

The study was conducted in a tertiary care multi-specialty hospital.

Participants and interventions

GFR was measured in 24 patients (mean age 56.6 ± 11.09 years, 20 male) undergoing elective off-pump coronary artery bypass grafting during preoperative period, intraoperative period, 24 h after surgery (ICU GFR), and on the fifth postoperative day (final GFR ).

Measurements and main results

Patients were divided into two groups depending upon changes in intraoperative GFR. Group 1 (n = 10): who had a rise in intraoperative GFR in comparison with preoperative baseline measurement. All these 10 (41.7 %) patients with a rise in intraoperative GFR had an uneventful hospital course and achieved an improvement in final GFR. Group 2 (n = 14): 14 (58.3 %) patients had a fall in intraoperative GFR (mean 36.4 %) in comparison with preoperative baseline value. Of these 14 patients, 1 patient required dialysis support and 3 patients required ionotropic support. Among these 14 patients in group two, 7 had deterioration in final GFR (mean 28.7 %), when compared to preoperative baseline value.

Conclusion

Postoperative renal dysfunction can be predicted from intraoperative GFR. Patients who have a rise in intraoperative GFR do not develop postoperative renal dysfunction, and only patients with intraoperative fall in GFR are at risk of postoperative renal dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Yates RB, Stafford-Smith M. The genetic determinants of renal impairment following cardiac surgery. Semin Cardiothorac Vasc Anesth. 2006;10:314–26.

    Article  PubMed  Google Scholar 

  2. Chukwuemeka A, Weisel A, Maganti M, et al. Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgery: a propensity score analysis. Ann Thorac Surg. 2005;80:2148–53.

    Article  PubMed  Google Scholar 

  3. Rahn KH, Heidenreich S, Bruckner D. How to assess glomerular function and damage in humans. J Hypertens. 1999;17:309–17.

    Article  CAS  PubMed  Google Scholar 

  4. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.

  5. Hilson AJ, Mistry RD, Maisey MN. 99Tcm-DTPA for the measurement of glomerular filtration rate. Br J Radiol. 1976;49:794–6.

    Article  CAS  PubMed  Google Scholar 

  6. Russell CD, Bischoff PG, Kontzen FN, et al. Measurement of glomerular filtration rate: single injection plasma clearance method without urine collection. J Nucl Med. 1985;26:1243–7.

    CAS  PubMed  Google Scholar 

  7. Ryden L, Ahnve S, Bell M, et al. Acute kidney injury after coronary artery bypass grafting and long term risk of myocardial infarction and death. Int J Cardiol. 2014;172:190–5.

    Article  PubMed  Google Scholar 

  8. Schopka S, Diez C, Camboni D, Floerchinger B, Schmid C, Hilkar M. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis. J Cardiothorac Surg. 2014;9:20.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Stafford-Smith M, Podgoreanu M, Swaminathan M, et al. Perioperative Genetics and Safety Outcomes Study (PEGASUS) Investigative Team: association of genetic polymorphisms with risk of renal injury after coronary bypass graft surgery. Am J Kidney Dis. 2005;45:519–30.

    Article  CAS  PubMed  Google Scholar 

  10. Chertow GM, Lazarus JM, Christiansen CL, et al. Preoperative renal risk stratification. Circulation. 1997;95:878–84.

    Article  CAS  PubMed  Google Scholar 

  11. Higuchi H, Sumita S, Wada H, et al. Effects of sevoflurane and isoflurane on renal function and on possible markers of nephrotoxicity. Anesthesiology. 1998;89:307–22.

    Article  CAS  PubMed  Google Scholar 

  12. Boldt J, Brenner T, Lehmann A, et al. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg. 2003;75:906–12.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular and Thoracic surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India

    Gauranga Majumdar, Surendra Kumar Agarwal, Shantanu Pande & Bipin Chandra

  2. Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Sukanta Barai

  3. Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Prabhat Tewari

Authors
  1. Gauranga Majumdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sukanta Barai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Surendra Kumar Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shantanu Pande
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bipin Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Prabhat Tewari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gauranga Majumdar.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Majumdar, G., Barai, S., Agarwal, S.K. et al. Can postoperative renal dysfunction be predicted by measuring intraoperative glomerular filtration rate in patients undergoing coronary artery bypass grafting without cardiopulmonary bypass? A pilot study. Indian J Thorac Cardiovasc Surg 32, 178–183 (2016). https://doi.org/10.1007/s12055-016-0444-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-016-0444-3

Keywords

Search

Navigation