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BJA Advance Access originally published online on April 9, 2008
British Journal of Anaesthesia 2008 100(6):759-764; doi:10.1093/bja/aen081
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Changes in glomerular filtration rate after cardiac surgery with cardiopulmonary bypass in patients with mild preoperative renal dysfunction

B. G. Loef1,*, R. H. Henning2, G. Navis3, A. J. Rankin5,{dagger}, W. van Oeveren1, T. Ebels1 and A. H. Epema4

1 Cardiothoracic Intensive Care Unit,
2 Department of Clinical Pharmacology,
3 Department of Nephrology,
4 Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
5 Pfizer Global Research and Development, Kent, UK

* Corresponding author. E-mail: b.loef{at}hccnet.nl.

Background: Cardiac surgery with cardiopulmonary bypass (CPB) is commonly perceived as a risk factor for decline in renal function, especially in patients with preoperative renal dysfunction. There are few data on the effects of CPB on renal function in patients with mild preoperative renal dysfunction. The purpose of this study was to evaluate renal function in patients with pre-existing mild renal dysfunction undergoing cardiac surgery with CPB.

Methods: In a multicentre study cohort we measured prospectively the glomerular filtration rate (GFR) by radioactive markers both before operation and on the 7th postoperative day in cardiac surgical patients with preoperative serum creatinine >120 µmol l–1 (n=56). In a subgroup of patients (n=14) in addition to the GFR, the effective renal plasma flow (ERPF) and the filtration fraction (FF) were measured.

Results: While preoperative GFR [77.9 (25.5) ml min–1] increased to 84.4 (23.7) ml min–1 (P=0.005) 1 week after surgery, ERPF did not change [295.8 (75.2) ml min–1 and 295.9 (75.9) ml min–1, respectively; P=0.8]. In accordance, the FF increased from 0.27 (0.05) (before operation) to 0.30 (0.04) (Day 7, P=0.01).

Conclusion: Our results oppose the view that cardiac surgery with CPB adversely affects renal function in patients with preoperative mild renal dysfunction and an uncomplicated clinical course.

Keywords: complications, renal; heart, cardiopulmonary bypass; kidney, function

{dagger} Declaration of interest. A. J. Rankin is a research employee of Pfizer Global Research and Development, Kent, UK.


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E-letters:

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Cardiac surgery, cardiopulmonary bypass and preoperative renal dysfunction.
Guillermo Lema, et al.
British Journal of Anaesthesia, 28 May 2008 [Full text]
Renal oxygen delivery during cardiopulmonary bypass
David J Morrice
British Journal of Anaesthesia, 19 Jun 2008 [Full text]
Re: Renal oxygen delivery during cardiopulmonary bypass
Berthus G Loef, et al.
British Journal of Anaesthesia, 29 Jun 2008 [Full text]
Re: Cardiac surgery, cardiopulmonary bypass and preoperative renal dysfunction.
Berthus G Loef, et al.
British Journal of Anaesthesia, 29 Jun 2008 [Full text]

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