Abstract
Acute renal failure requiring hemodialysis therapy after coronary artery bypass surgery occurs in 1 to 5% of patients, however, the optimal timing for initiation of hemodialysis therapy still remains undetermined. To assess when continuous hemodialysis therapy is begun, we studied the comparative survival between 14 patients who started to receive continuous hemodialysis therapy with the timing of decrease of urine volume less than 30 ml/hr and other 14 patients who waited to begin dialysis therapy until the level of urine volume of less than 20 ml/hr during 14 days. Between two groups, there were no significant differences in age, sex ratio, the score of APACHE (Acute Physiologic and Chronic Health Evaluation) II, and the levels of serum creatinine at the start of continuous hemodialysis therapy (2.9±0.2 vs 3.1±0.2 mg/dl) as well as the levels of serum creatinine at admission. Overall mortality of those patients was 50%. Twelve of fourteen patients who received continuous hemodialysis therapy with the timing of decrease of urine volume less than 30 ml/hour. In contrast, only 2 of 14 patients in the other group survived. There was a significant difference of p<0.01 between two groups. The initiation of treatment for acute renal failure following after coronary artery bypass surgery would be determined by the decrease of urine volume but not the levels of serum creatinine. The early start of continuous hemodialysis therapy might be preferable for improvement of survival of the patients suffered from acute renal failure following coronary artery bypass surgery.
