Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery

Paul Bent, Han Khim Tan, Rinaldo Bellomo, Jonathan Buckmaster, Laurie Doolan, Graeme Hart, William Silvester, Geoffrey Gutteridge, George Matalanis, Jai Raman, Alexander Rosalion, Brian F. Buxton

Research output: Contribution to journalArticleResearchpeer-review

112 Citations (Scopus)

Abstract

Background. The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Methods. Medical record analysis with collection of demographic, clinical, and outcome information was used. Results. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Conclusions. Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.

Original languageEnglish
Pages (from-to)832-837
Number of pages6
JournalAnnals of Thoracic Surgery
Volume71
Issue number3
DOIs
Publication statusPublished - 24 Mar 2001
Externally publishedYes

Cite this

Bent, Paul ; Tan, Han Khim ; Bellomo, Rinaldo ; Buckmaster, Jonathan ; Doolan, Laurie ; Hart, Graeme ; Silvester, William ; Gutteridge, Geoffrey ; Matalanis, George ; Raman, Jai ; Rosalion, Alexander ; Buxton, Brian F. / Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. In: Annals of Thoracic Surgery. 2001 ; Vol. 71, No. 3. pp. 832-837.
@article{a91edea124bf4ba89833acd3d6b096ab,
title = "Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery",
abstract = "Background. The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Methods. Medical record analysis with collection of demographic, clinical, and outcome information was used. Results. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9{\%}), single valve procedure (16.9{\%}), or combined operations (26.2{\%}). In 32.3{\%} of patients, intraaortic balloon counterpulsation was required and 20{\%} of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40{\%} of patients and prolonged mechanical ventilation in 58.5{\%}. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66{\%}. Actual mortality was 40{\%} (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Conclusions. Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.",
author = "Paul Bent and Tan, {Han Khim} and Rinaldo Bellomo and Jonathan Buckmaster and Laurie Doolan and Graeme Hart and William Silvester and Geoffrey Gutteridge and George Matalanis and Jai Raman and Alexander Rosalion and Buxton, {Brian F.}",
year = "2001",
month = "3",
day = "24",
doi = "10.1016/S0003-4975(00)02177-9",
language = "English",
volume = "71",
pages = "832--837",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier",
number = "3",

}

Bent, P, Tan, HK, Bellomo, R, Buckmaster, J, Doolan, L, Hart, G, Silvester, W, Gutteridge, G, Matalanis, G, Raman, J, Rosalion, A & Buxton, BF 2001, 'Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery', Annals of Thoracic Surgery, vol. 71, no. 3, pp. 832-837. https://doi.org/10.1016/S0003-4975(00)02177-9

Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. / Bent, Paul; Tan, Han Khim; Bellomo, Rinaldo; Buckmaster, Jonathan; Doolan, Laurie; Hart, Graeme; Silvester, William; Gutteridge, Geoffrey; Matalanis, George; Raman, Jai; Rosalion, Alexander; Buxton, Brian F.

In: Annals of Thoracic Surgery, Vol. 71, No. 3, 24.03.2001, p. 832-837.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery

AU - Bent, Paul

AU - Tan, Han Khim

AU - Bellomo, Rinaldo

AU - Buckmaster, Jonathan

AU - Doolan, Laurie

AU - Hart, Graeme

AU - Silvester, William

AU - Gutteridge, Geoffrey

AU - Matalanis, George

AU - Raman, Jai

AU - Rosalion, Alexander

AU - Buxton, Brian F.

PY - 2001/3/24

Y1 - 2001/3/24

N2 - Background. The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Methods. Medical record analysis with collection of demographic, clinical, and outcome information was used. Results. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Conclusions. Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.

AB - Background. The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Methods. Medical record analysis with collection of demographic, clinical, and outcome information was used. Results. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Conclusions. Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.

UR - http://www.scopus.com/inward/record.url?scp=0035101842&partnerID=8YFLogxK

U2 - 10.1016/S0003-4975(00)02177-9

DO - 10.1016/S0003-4975(00)02177-9

M3 - Article

C2 - 11269461

AN - SCOPUS:0035101842

VL - 71

SP - 832

EP - 837

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 3

ER -