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Canadian Journal of Anesthesia 51:A53 (2004)
© Canadian Anesthesiologists' Society, 2004

Abstracts - Tuesday June 22nd 2004 0800-1000

THE DEGREE OF HEMODILUTION IN CPB IS RELATED TO RENAL FAILURE IN CARDIAC SURGERY

Keyvan Karkouti, MD, Scott Beattie, MD, Duminda Wijeysundera, MD, Chris Chan, MD, Vivek Rao, MD, Kathleen Datillo, MD, George Djaiani, MD, Joan Ivano, PhD and Jacek Karski, MD

Departments of Anesthesia, Nephrology and Division of Cardiac Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario M5G 2C4

INTRODUCTION: This observational study sought to determine if the degree of hemodilution during cardiopulmonary bypass (CPB) is independently related to perioperative acute renal failure (ARF).

METHODS: Following REB approval data were prospectively collected on consecutive patients undergoing cardiac surgery with CPB from 1999 to 2003 at a quaternary care hospital. The independent relationship between degrees of hemodilution during CPB, as measured by nadir hematocrit concentration (nHct), and ARF was assessed by multivariable logistic regression to control for variables known to be associated with perioperative renal failure and anemia.

RESULTS: Of the 9080 patients included in the analysis, 1.5% (n=134) developed ARF. There was an independent, u-shaped relationship between nHct during CPB and ARF. Moderate hemodilution (nHct 21–26%) was associated with the lowest risk of ARF, with the risk increasing as nHct deviated from this range in either direction. Compared to moderate hemodilution, the adjusted odds ration for ARF with severe hemodilution (nHct<21%) was 2.2 (95% C.I. =1.4–3.5), and for mild hemodilution (nHct>26%) was 2.1 (95% C.I. = 1.1–4.0): P= 0.03.

CONCLUSION: Since there is an independent relationship between the degree of hemodilution during CPB and perioperative ARF, patient outcomes may be improved if the nHct during CPB is kept within the identified ‘optimal’ range. Randomized clinical trials, however, are needed to determine if this is a cause-effect relationship or simply an association.



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  		Figure 1. Estimated spline transformation and 95% confidence interval for nadir hematocrit and ARF

 




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