Cardiac surgery in patients with end-stage renal disease
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Objectives: The number of patients with end-stage renal disease undergoing open heart surgery continues to grow. We evaluated continuous ambulatory peritoneal dialysis and the extracorporeal ultrafiltration method during cardiopulmonary bypass in the management of these difficult patients.Methods: These 2 methods were used in 4 patients with renal failure who underwent open heart surgery between July 1997 and March 1999. Preoperative continuous ambulatory peritoneal dialysis was conducted using standard protocols. Extracorporeal ultrafiltration method was used only during cardiopulmonary bypass. Continuous ambulatory peritoneal dialysis was initiated upon arrival at the intensive care unit. Mean follow-up was 12 months.Results: Postoperative blood urea nitrogen and creatinine concentrations were lower than preoperative concentrations. No patients required hemodialysis. All 4 patients were discharged to their homes. No deaths occurred.Conclusions: Continuous ambulatory peritoneal dialysis and extracorporeal ultrafiltration method are combined to treat patients with end-stage renal disease who require open heart surgery. This combination is simple, and does not require specialized personnel, and obviates the hemodynamic instability associated with hemodialysis.
Key wordsopen-heart surgery continuous ambulatory peritoneal dialysis extracorporeal ultrafiltration method
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- 5.Saigenji H, Nakamura N, Toyohira H, Shimokawa S, Moriyama Y, Taira A. Open heart surgery in patients with chronic dialysis. J Jpn Assn Thorac Surg 1996; 44: 853–7.Google Scholar
- 6.Iida H, Okamura Y, Mochizuki Y, Mori H, Yamada Y, Shibasaki I, et al. Beneficial effects of continuous hemodiafiltration after cardiac surgery in patients with chronic renal failure. J Jpn Assn Thorac Surg 1997; 45: 550–5.Google Scholar
- 8.Kitamura M, Yamasaki K, Takemura T, Takasawa A, Kawai A, Shikawa A, et al. Cardiac surgery in chronic dialysis patients: usefulness of continuous ambulatory peritoneal dialysis (CAPD). J Jpn Assn Thorac Surg 1989; 37: 2507–12.Google Scholar
- 9.Mayumi H, Uchida T, Fukae K, Umesue M, Kohno H, Shinozaki K, et al. Effects of open-heart surgery on renal function in patients with chronic renal failure. Is hemodialysis during cardiopulmonary bypass really required? J Jpn Assn Thorac Surg 1992; 40: 1839–46.Google Scholar
- 11.Hoshino R, Okubo T, Kaneko K, Goko C. Cardiac surgery in hemodialysis patients. J Jpn Assn Thorac Surg 1993; 41: 1143–8.Google Scholar
- 12.Nomoto S, Okamoto Y, Ishihara Y, Yoshimoto F, Tsuchiya T. Clinical evaluation of the new PES hemoconcentrator LH-420P. Jpn J Artif Organs 1991; 20: 1465–9.Google Scholar