Early dialysis in acute kidney injury after cardiac surgery
Alexander R. Manche 1,
Aaron R. Casha 1*,
Jacek Rychter 1,
Emanuel Farrugia 1,
Miriam Debono 1
1 Mater Dei Hospital, Malta
* To whom correspondence should be addressed. E-mail: casha{at}waldonet.net.mt.
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Abstract |
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Acute kidney injury following cardiac surgery (AKICS) remains a frequent cause of major morbidity and mortality. The aim of this study was to examine the influence of timing of dialysis. A retrospective analysis of 3528 patients undergoing cardiac surgery between April 1995 and July 2006 was performed. In group 1 (April 1995-January 2000) intermittent haemodialysis was resorted to when other supportive measures failed. In group 2 (January 2000-July 2006) intermittent haemodialysis was commenced immediately when oliguria did not respond to fluid replacement or single-dose diuretics. In group 1, 49/1511 (3.2%) patients developed AKICS. 34 patients did not receive dialysis and 6 patients died (18%). Of the remaining 15 patients who underwent dialysis 13 died (87%). The overall mortality for group 1 AKICS patients was 19/49 (39%). In group 2, 87/2017 (4.3%) patients developed AKICS. 31 patients did not require dialysis and none died. Of the 56 patients who were dialysed, 14 died (25%). During January 2005-July 2006, mortality following dialysis fell further to 17% (4/24). The overall mortality for group 2 patients developing AKICS was 14/87 (16%). Although the incidence of AKICS increased from 3.2% to 4.2%, earlier dialysis resulted in significantly improved survival (p = 0.00001). Keywords: Acute kidney injury; Cardiac surgery; Early dialysis; Outcome
