Kidney Protection by Continuous Hemodiafiltration during and Post Cardiopulmonary Bypass

Martin Friedrich, Terezia B Andrasi, Johanna Kolle, George Awad, Saddam MA Al-Sabri and Theodoros Tirilomis

Department of Thoracic, Cardiac and Vascular Surgery, University of Göttingen, Germany
Department of Cardiovascular Surgery, Philipps University of Marburg, Germany
Both authors contributed equally to this study

^*Correspondance to: Terezia B Andrasi 

 PDF  Full Text DOI: 10.25107/2474-1647.2470

Abstract

Background: Although continuous hemodiafiltration may protect the kidney by removing inflammatory cytokines released during Cardiopulmonary Bypass (CPB), it remains rather controversial whether renal replacement therapy could also remove end-products of hemolysis that are thought to play a central role in the development of acute kidney injury (AKI) after cardiac surgery with CPB.
Methods: The incidence of AKI has been investigated in two groups of patients undergoing coronary surgery with CPB either with (n=17) or without (n=16) continuous intraoperative and 6 h postoperative hemodiafiltration by perioperatively monitoring plasma free hemoglobin (fHb) and haptoglobin levels, retention parameters and diuresis.
Results: Plasma fHb increased in both groups during CPB (p<0.05), whereas urinary fHb was not influenced by hemodiafiltration. Plasma haptoglobin reserve was similarly depleted postoperatively in both groups without reaching a critical level. Filtration significantly improved urine output during CPB (418.07 ± 386.86 vs. 224.82 ± 130.7, p<0.05), reduced postoperative AKI score (p<0.05) and maintained creatinine levels at baseline up to the 10th postoperative day.
Conclusion: Continuous hemodiafiltration during CPB does not remove fHb, but reduces transfusion by increasing acid excretion and urine output thus indirectly diminishing the degree of intravascular hemolysis and the risk for AKI after cardiac surgery.

Keywords

Acute kidney injury; Free hemoglobin; Hemodiafiltration; Cardiopulmonary bypass

Cite the article

Friedrich M, Andrasi TB, Kolle J, Awad G, Al-Sabri SMA, Tirilomis T. Kidney Protection by Continuous Hemodiafiltration during and Post Cardiopulmonary Bypass. Clin Surg. 2019; 4: 2470.