Intraoperative Hemodialysis During Open-Heart Surgery in Patients With Severe Chronic Kidney Disease

Abstract Background:Acute kidney injury and chronic kidney disease (CKD) after cardiac surgery are associated with increased mortality and renal prognosis. We evaluated the utility of intraoperative hemodialysis (IHD) during open-heart surgery of patients with severe CKD.Methods:The present study was a single-center retrospective cohort study employing IHD for non-emergency open-heart surgery in patients with CKD G4 or G5. We compared the patients in IHD group with those in the non-IHD group retrospectively. Primary outcomes were 30-day mortality and initiation of renal replacement therapy (RRT) after surgery.Results:Twenty-eight patients were categorized into the IHD group and 33 into the non-IHD group. Comparing the IHD versus the non-IHD, men accounted for 60.7 vs. 50.3%, the age was mean 74.5 (SD 7.0) vs. 72.9 (SD 9.4) years (p=0.744), and the rate of CKD G4 patients was 67.9 % vs. 84.8 %. On the other hand, preoperative estimated glomerular filtration rate of the IHD is significantly lower than the non-IHD (19.1 ± 5.6 vs. 22.0 ± 5.2 ml/min/1.73 m2, p=0.039). For clinical outcomes, no significant differences were observed in 90-day mortality (7.1 vs. 3.0 %, p=0.482) and 30-day RRT rate (17.9 vs 30.3%, p=0.261). In the patients with CKD G4, the 30-day RRT rate was significantly lower in patients in the IHD than in those in the non-IHD (0 vs. 25.0%, p=0.037). Conclusions:IHD during open-heart surgery reduced the incidence of postoperative dialysis in patients with CKD G4 and may be useful for postoperative management.