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Erschienen in: General Thoracic and Cardiovascular Surgery 9/2023

13.03.2023 | Original Article

Clinical outcome of intraoperative hemodialysis using a hemoconcentrator during cardiopulmonary bypass for dialysis-dependent patients

verfasst von: Satoshi Ohtsubo, Takahito Itoh, Yujiro Kawai, Kanako Kobayashi, Shuichiro Yoshitake, Naoki Fujimura, Yuta Shoji, Shuichi Ishii

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 9/2023

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Abstract

Objectives

The basic materials and structure of a hemoconcentrator incorporated into cardiopulmonary bypass (CPB) circuits are similar to those of hemodialyzers. Gravity drainage hemodiafiltration (GHDF) is an easy-to-use intraoperative renal replacement therapy (RRT) that utilizes a hemoconcentrator. This study aimed to verify whether GHDF can correct electrolyte imbalance and remove uremic toxins in dialysis-dependent patients and to evaluate the clinical outcomes of GHDF by comparing it with a conventional method of dilutional ultrafiltration (DUF).

Methods

This study retrospectively compared perioperative clinical values of 41 dialysis-dependent patients (21 patients with GHDF and 20 patients with DUF) who underwent open-heart surgery. Changes in serum parameters before and after passing through the hemoconcentrator were also compared.

Results

Compared to DUF, GHDF significantly lowered potassium, blood urea nitrogen, and creatinine levels at the outflow of the hemoconcentrator. Less catecholamine was needed to wean CPB in GHDF than in DUF. The P/F ratio (arterial blood oxygen pressure/inhaled oxygen concentration) at the end of surgery was significantly higher in GHDF than in DUF (450.8 ± 149.7 vs. 279.3 ± 153.5; p < 0.001). Postoperative intubation time was shorter in GHDF than in DUF (8.3 ± 5.9 vs. 18.7 ± 16.1 h; p = 0.006). The major morbidity and mortality rates were comparable in both groups.

Conclusions

GHDF removed both potassium and uremic toxins more efficiently than DUF in dialysis-dependent patients. Less catecholamine was needed to wean CPB using GHDF. It improved the immediate postoperative respiratory function and enabled earlier extubation. GHDF is a novel and effective option for intraoperative RRT in dialysis-dependent patients undergoing open-heart surgery.
Literatur
1.
Zurück zum Zitat Kamohara K, Yoshikai M, Yunoki J, Fumoto H. Safety of perioperative hemodialysis and continuous hemodiafiltration for dialysis patients with cardiac surgery. Gen Thorac Cardiovasc Surg. 2007;55:43–9. CrossRefPubMed Kamohara K, Yoshikai M, Yunoki J, Fumoto H. Safety of perioperative hemodialysis and continuous hemodiafiltration for dialysis patients with cardiac surgery. Gen Thorac Cardiovasc Surg. 2007;55:43–9. CrossRefPubMed
2.
Zurück zum Zitat Murkin JM, Murphy DA, Finlayson DC, Waller JL. Hemodialysis during cardiopulmonary bypass: report of twelve cases. Anesth Analg. 1987;66:899–901. CrossRefPubMed Murkin JM, Murphy DA, Finlayson DC, Waller JL. Hemodialysis during cardiopulmonary bypass: report of twelve cases. Anesth Analg. 1987;66:899–901. CrossRefPubMed
3.
Zurück zum Zitat Ilson BE, Bland PS, Jorkasky DK, Shusterman N, Allison NL, Dubb JW, et al. Intraoperative versus routine hemodialysis in end-stage renal disease patients undergoing open-heart surgery. Nephron. 1992;61:170–5. CrossRefPubMed Ilson BE, Bland PS, Jorkasky DK, Shusterman N, Allison NL, Dubb JW, et al. Intraoperative versus routine hemodialysis in end-stage renal disease patients undergoing open-heart surgery. Nephron. 1992;61:170–5. CrossRefPubMed
4.
Zurück zum Zitat Khoo MS, Braden GL, Deaton D, Owen S, Germain M, O’Shea M, et al. Outcome and complications of intraoperative hemodialysis during cardiopulmonary bypass with potassium-rich cardioplegia. Am J Kidney Dis. 2003;41:1247–56. CrossRefPubMed Khoo MS, Braden GL, Deaton D, Owen S, Germain M, O’Shea M, et al. Outcome and complications of intraoperative hemodialysis during cardiopulmonary bypass with potassium-rich cardioplegia. Am J Kidney Dis. 2003;41:1247–56. CrossRefPubMed
5.
Zurück zum Zitat Hakim M, Wheeldon D, Bethune DW, Milstein BB, English TA, Wallwork J. Haemodialysis and haemofiltration on cardiopulmonary bypass. Thorax. 1985;40:101–6. CrossRefPubMedPubMedCentral Hakim M, Wheeldon D, Bethune DW, Milstein BB, English TA, Wallwork J. Haemodialysis and haemofiltration on cardiopulmonary bypass. Thorax. 1985;40:101–6. CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Frenken M, Krian A. Cardiovascular operations in patients with dialysis-dependent renal failure. Ann Thorac Surg. 1999;68:887–93. CrossRefPubMed Frenken M, Krian A. Cardiovascular operations in patients with dialysis-dependent renal failure. Ann Thorac Surg. 1999;68:887–93. CrossRefPubMed
7.
Zurück zum Zitat Franga DL, Kratz JM, Crumbley AJ, Zellner JL, Stroud MR, Crawford FA. Early and long-term results of coronary artery bypass grafting in dialysis patients. Ann Thorac Surg. 2000;70:813–8. CrossRefPubMed Franga DL, Kratz JM, Crumbley AJ, Zellner JL, Stroud MR, Crawford FA. Early and long-term results of coronary artery bypass grafting in dialysis patients. Ann Thorac Surg. 2000;70:813–8. CrossRefPubMed
8.
Zurück zum Zitat Hirai K, Sasaki A, Kondo T, Akiyama T, Kanauchi A, Amada N, et al. Development and clinical evaluation of gravity drainage type hemodiafiltration method for correction of hyperkalemia during extracorporeal circulation in open heart surgery. Jpn J Extra-Corporeal Technol. 2013;40:149–54. CrossRef Hirai K, Sasaki A, Kondo T, Akiyama T, Kanauchi A, Amada N, et al. Development and clinical evaluation of gravity drainage type hemodiafiltration method for correction of hyperkalemia during extracorporeal circulation in open heart surgery. Jpn J Extra-Corporeal Technol. 2013;40:149–54. CrossRef
9.
Zurück zum Zitat Hashimoto K, Nogimoto T, Tani S, Fujikawa D, Nakao Y. The usefulness of gravity drainage hemodiafiltration in the management of hyperkalemia. Jpn J Extra-Corporeal Technology. 2017;44:385–9. Hashimoto K, Nogimoto T, Tani S, Fujikawa D, Nakao Y. The usefulness of gravity drainage hemodiafiltration in the management of hyperkalemia. Jpn J Extra-Corporeal Technology. 2017;44:385–9.
10.
Zurück zum Zitat Journois D, Israel-Biet D, Pouard P, Rolland B, Silvester W, Vouhé P, et al. High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children. Anesthesiology. 1996;85:965–76. CrossRefPubMed Journois D, Israel-Biet D, Pouard P, Rolland B, Silvester W, Vouhé P, et al. High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children. Anesthesiology. 1996;85:965–76. CrossRefPubMed
11.
Zurück zum Zitat Heath M, Barbeito A, Welsby I, Maxwell C, Iribarne A, Raghunathan K. Using zero-balance ultrafiltration with dialysate as a replacement solution for toxin and eptifibatide removal on a dialysis-dependent patient during cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2016;30:162–8. CrossRefPubMed Heath M, Barbeito A, Welsby I, Maxwell C, Iribarne A, Raghunathan K. Using zero-balance ultrafiltration with dialysate as a replacement solution for toxin and eptifibatide removal on a dialysis-dependent patient during cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2016;30:162–8. CrossRefPubMed
12.
Zurück zum Zitat Huang H, Yao T, Wang W, Zhu D, Zhang W, Chen H, et al. Continuous ultrafiltration attenuates the pulmonary injury that follows open heart surgery with cardiopulmonary bypass. Ann Thorac Surg. 2003;76:136–40. CrossRefPubMed Huang H, Yao T, Wang W, Zhu D, Zhang W, Chen H, et al. Continuous ultrafiltration attenuates the pulmonary injury that follows open heart surgery with cardiopulmonary bypass. Ann Thorac Surg. 2003;76:136–40. CrossRefPubMed
13.
Zurück zum Zitat Yamashita C, Hara Y, Kuriyama N, Nakamura T, Nishida O. Clinical effects of a longer duration of polymyxin b-immobilized fiber column direct hemoperfusion therapy for severe sepsis and septic shock. Ther Apher Dial. 2015;19:316–23. CrossRefPubMed Yamashita C, Hara Y, Kuriyama N, Nakamura T, Nishida O. Clinical effects of a longer duration of polymyxin b-immobilized fiber column direct hemoperfusion therapy for severe sepsis and septic shock. Ther Apher Dial. 2015;19:316–23. CrossRefPubMed
14.
Zurück zum Zitat Motomura N, Miyata H, Tsukihara H, Takamoto S. Japan Cardiovascular Surgery Database Organization. Risk model of thoracic aortic surgery in 4707 cases from a nationwide single-race population through a web-based data entry system: the first report of 30-day and 30-day operative outcome risk models for thoracic aortic surgery. Circulation. 2008;118:S153–9. CrossRefPubMed Motomura N, Miyata H, Tsukihara H, Takamoto S. Japan Cardiovascular Surgery Database Organization. Risk model of thoracic aortic surgery in 4707 cases from a nationwide single-race population through a web-based data entry system: the first report of 30-day and 30-day operative outcome risk models for thoracic aortic surgery. Circulation. 2008;118:S153–9. CrossRefPubMed
15.
Zurück zum Zitat Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734–44. CrossRefPubMed Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734–44. CrossRefPubMed
16.
Zurück zum Zitat Bäck C, Hornum M, Møller CJH, Olsen PS. Cardiac surgery in patients with end-stage renal disease on dialysis. Scand Cardiovasc J. 2017;51:334–8. CrossRefPubMed Bäck C, Hornum M, Møller CJH, Olsen PS. Cardiac surgery in patients with end-stage renal disease on dialysis. Scand Cardiovasc J. 2017;51:334–8. CrossRefPubMed
17.
Zurück zum Zitat Horst M, Mehlhorn U, Hoerstrup SP, Suedkamp M, de Vivie ER. Cardiac surgery in patients with end-stage renal disease: 10-year experience. Ann Thorac Surg. 2000;69:96–101. CrossRefPubMed Horst M, Mehlhorn U, Hoerstrup SP, Suedkamp M, de Vivie ER. Cardiac surgery in patients with end-stage renal disease: 10-year experience. Ann Thorac Surg. 2000;69:96–101. CrossRefPubMed
18.
Zurück zum Zitat Mukaida H, Matsushita S, Inotani T, Nakamura A, Amano A. Continuous renal replacement therapy with a polymethyl methacrylate membrane hemofilter suppresses inflammation in patients after open-heart surgery with cardiopulmonary bypass. J Artif Organs. 2018;21:188–95. CrossRefPubMed Mukaida H, Matsushita S, Inotani T, Nakamura A, Amano A. Continuous renal replacement therapy with a polymethyl methacrylate membrane hemofilter suppresses inflammation in patients after open-heart surgery with cardiopulmonary bypass. J Artif Organs. 2018;21:188–95. CrossRefPubMed
19.
Zurück zum Zitat Otaki M, Enmoto T, Oku H. Coronary bypass grafting for patients dependent on dialysis: modified ultrafiltration for perioperative management. ASAIO J. 2003;49:650–4. CrossRefPubMed Otaki M, Enmoto T, Oku H. Coronary bypass grafting for patients dependent on dialysis: modified ultrafiltration for perioperative management. ASAIO J. 2003;49:650–4. CrossRefPubMed
20.
Zurück zum Zitat Tagaya M, Matsuda M, Yakehiro M, Izutani H. Features of an alternative hemodialysis method using a hemoconcentrator during cardiopulmonary bypass surgeries. Perfusion. 2015;30:318–22. CrossRefPubMed Tagaya M, Matsuda M, Yakehiro M, Izutani H. Features of an alternative hemodialysis method using a hemoconcentrator during cardiopulmonary bypass surgeries. Perfusion. 2015;30:318–22. CrossRefPubMed
21.
Zurück zum Zitat Kubota T, Miyata A, Maeda A, Hirota K, Koizumi S, Ohba H. Continuous haemodiafiltration during and after cardiopulmonary bypass in renal failure patients. Can J Anaesth. 1997;44:1182–6. CrossRefPubMed Kubota T, Miyata A, Maeda A, Hirota K, Koizumi S, Ohba H. Continuous haemodiafiltration during and after cardiopulmonary bypass in renal failure patients. Can J Anaesth. 1997;44:1182–6. CrossRefPubMed
22.
Zurück zum Zitat Hamilton CC, Harwood SJ, Deemar KA, Juhasz S, Sharpe E. Haemodialysis during cardiopulmonary bypass using a haemofilter. Perfusion. 1994;9:135–9. CrossRefPubMed Hamilton CC, Harwood SJ, Deemar KA, Juhasz S, Sharpe E. Haemodialysis during cardiopulmonary bypass using a haemofilter. Perfusion. 1994;9:135–9. CrossRefPubMed
23.
Zurück zum Zitat Matata BM, Scawn N, Morgan M, Shirley S, Kemp I, Richards S, et al. A single-center randomized trial of intraoperative zero-balanced ultrafiltration during cardiopulmonary bypass for patients with impaired kidney function undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2015;29:1236–47. CrossRefPubMed Matata BM, Scawn N, Morgan M, Shirley S, Kemp I, Richards S, et al. A single-center randomized trial of intraoperative zero-balanced ultrafiltration during cardiopulmonary bypass for patients with impaired kidney function undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2015;29:1236–47. CrossRefPubMed
24.
Zurück zum Zitat Nagashima M, Shin’oka T, Nollert G, Shum-Tim D, Rader CM, Mayer JE Jr. High-volume continuous hemofiltration during cardiopulmonary bypass attenuates pulmonary dysfunction in neonatal lambs after deep hypothermic circulatory arrest. Circulation. 1998;98:378–84. Nagashima M, Shin’oka T, Nollert G, Shum-Tim D, Rader CM, Mayer JE Jr. High-volume continuous hemofiltration during cardiopulmonary bypass attenuates pulmonary dysfunction in neonatal lambs after deep hypothermic circulatory arrest. Circulation. 1998;98:378–84.
26.
Zurück zum Zitat Elayashy M, Madkour MA, Mahmoud AAA, Hosny H, Hussein A, Nabih A, et al. Effect of ultrafiltration on extravascular lung water assessed by lung ultrasound in children undergoing cardiac surgery: a randomized prospective study. BMC Anesthesiol. 2019;19:93. CrossRefPubMedPubMedCentral Elayashy M, Madkour MA, Mahmoud AAA, Hosny H, Hussein A, Nabih A, et al. Effect of ultrafiltration on extravascular lung water assessed by lung ultrasound in children undergoing cardiac surgery: a randomized prospective study. BMC Anesthesiol. 2019;19:93. CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Kosour C, Dragosavac D, Antunes N, Almeida de Oliveira RA, Martins Oliveira PP, Wilson VR. Effect of ultrafiltration on pulmonary function and interleukins in patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2016;30:884–90. CrossRefPubMed Kosour C, Dragosavac D, Antunes N, Almeida de Oliveira RA, Martins Oliveira PP, Wilson VR. Effect of ultrafiltration on pulmonary function and interleukins in patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2016;30:884–90. CrossRefPubMed
28.
Zurück zum Zitat Zhang H, Fan L, Liao H, Tu L, Zhang J, Xu D, Feng J. Correlations of cardiac function with inflammation, oxidative stress and anemia in patients with uremia. Exp Ther Med. 2021;21:250. CrossRefPubMedPubMedCentral Zhang H, Fan L, Liao H, Tu L, Zhang J, Xu D, Feng J. Correlations of cardiac function with inflammation, oxidative stress and anemia in patients with uremia. Exp Ther Med. 2021;21:250. CrossRefPubMedPubMedCentral
Metadaten
Titel
Clinical outcome of intraoperative hemodialysis using a hemoconcentrator during cardiopulmonary bypass for dialysis-dependent patients
verfasst von
Satoshi Ohtsubo
Takahito Itoh
Yujiro Kawai
Kanako Kobayashi
Shuichiro Yoshitake
Naoki Fujimura
Yuta Shoji
Shuichi Ishii
Publikationsdatum
13.03.2023
Verlag
Springer Nature Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 9/2023
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-023-01922-x

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