Efficacy of high flow-volume continuous hemodiafiltration (CHDF) in cases of circulatory failure following cardiac surgery under cardiopulmonary bypass complicated with cardiac surgery-associated acute kidney injury

Abstract

While prognoses are worsened by the development of cardiac surgery-associated acute kidney injury (CSA-AKI) following cardiac surgery, it has been reported that prognoses can improve if continuous renal replacement therapy (CRRT) is conducted at an early stage of within 3 days of the surgery. However, indications for this procedure and mechanisms underlying the improved prognosis remain unclear. The present study retrospectively assessed the efficacy of high flow-volume CHDF in 8 cases of circulatory failure following cardiac surgery under cardiopulmonary bypass complicated with CSA-AKI. Improvements were noted in various hemodynamic parameters following initiation of high flow-volume CHDF, and the catecholamine index (CAI) significantly decreased. Concentrations of serum lactate and serum IL-6 and body temperature also significantly decreased while urine volume significantly increased following high flow-volume CHDF. Details regarding the procedure were as follows: days to CRRT initiation following surgery, 1.6 days; duration of high flow-volume CHDF, 2.3 days; total number of days of CRRT, 8.6 days; ICU stay, 13.1 days; transition to maintenance dialysis, 0％; 28day survival, 100％; and in-hospital survival rate, 87.5%. Our findings suggest that early initiation of high flow-volume CHDF in cases of circulatory failure following cardiac surgery under cardiopulmonary bypass complicated with CSA-AKI is effective, as reflected by improved hemodynamic parameters and renal function.