Renal Dysfunction in the Perioperative Period

Abstract

The incidence of acute renal failure (ARF) in hospitalized patients is 2–5% [1, 2]. For postoperative ARF an incidence of up to 30% has been described [3]. In the perioperative period renal dysfunction is more frequent in cardiac and vascular surgery [1, 3]. Also, the patient’s previous health status regarding renal, cardiovascular and pulmonary function influences the incidence and severity of renal dysfunction postoperatively [2]. As important as the patient’s history is the preoperative status (preoperative renal failure, cardiac failure). If the patient undergoes an emergency operation, the incidence of ARF becomes up to 10-fold higher in comparison to elective surgery [4, 5]. These patients often require support postoperatively in the intensive care unit (ICU). ARF develops in the ICU in up to 25% of patients [6, 7]. ARF in these patients is often part of Multiple-Organ-Dysfunction-Syndrome (MODS). The mortality increases with the number of organs failing. MODS alone has a mortality rate of up to 15% [6, 7]. If ARF is part of MODS then the mortality increases to over 50% [2]. Nevertheless, ARF has been independently associated with postoperative mortality [8]. If postoperative ARF occurs isolated, mortality is reported to be 10% [4].