Early Application of Continuous Hemodiafiltration (CHDF) after Open Heart Surgery on Hemodialysis Patients
10.4326/jjcvs.39.300
- VernacularTitle:慢性血液透析症例の開心術における術後早期持続血液透析瀘過（CHDF）の有用性
- Author:
Mitsuhiro Yamamura
;
Masataka Mitsuno
;
Hiroe Tanaka
;
Masaaki Ryomoto
;
Shinya Fukui
;
Yoshiteru Yoshioka
;
Tetsuya Kajiyama
;
Yuji Miyamoto
- Publication Type:Journal Article
- Keywords:
open heart surgery;
hemodialysis;
continuous hemodiafiltration (CHDF)
- From:Japanese Journal of Cardiovascular Surgery
2010;39(6):300-304
- CountryJapan
- Language:Japanese
-
Abstract:
This study aimed to clarify whether continuous hemodiafiltration (CHDF) or hemodialysis (HD) was more effective after open heart surgery in dialysis patients. We evaluated 48 consecutive hemodialysis patients (28 men and 20 women, mean age : 68±10 years) who underwent coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) between January 2003 and December 2008. The patients were divided into 2 groups according to their postoperative dialysis treatment either continuous hemodiafiltration (CHDF) (CHDF group, n=36) or hemodialysis (HD) (HD group, n=12). Surgery in the CHDF group included 13 concomitant operations, 16 CABGs and 7 AVRs. There was only 1 concomitant surgery in the HD group, and there were 6 CABGs and 5 AVRs. There was no difference between the 2 groups regarding operation time, aortic clamp time, cardiopulmonary bypass time or intraoperative volume balance. CHDF was started significantly earlier than HD (8.0±5.8 vs. 21.0±1.0 h, p <0.01), which resulted in the removal of a greater volume of body fluid, during the first postoperative 24 h in the CHDF group (1,200±110 vs. 550±50 ml, p <0.01). However, there was no difference between the 2 groups regarding the amount of postoperative chest drainage. There were 6 hospital deaths in the CHDF group (17% ; 3 heart failures, and 1 each of pneumonia, arrhythmia and massive intestinal necrosis). There was also 1 hospital death in the HD group (8.3% ; heart failure). Most of the hospital deaths occurred after concomitant operations (6/7, 86%). It is beneficial to start CHDF soon after open heart surgery in hemodialysis patients.
