Outcome and complications of intraoperative hemodialysis during cardiopulmonary bypass with potassium-rich cardioplegia.
Author Department
Medicine; Surgery
Document Type
Article, Peer-reviewed
Publication Date
6-1-2003
Abstract
BACKGROUND: Potassium-rich cardioplegia has advantages over other cardioplegic solutions in preserving the myocardium during cardiopulmonary bypass, but it is avoided in patients with renal failure because of hyperkalemia. METHODS: We first determined the ability of intraoperative hemodialysis (IHD) to remove potassium during cardiopulmonary bypass with potassium-rich cardioplegia in 9 patients by measuring potassium levels in all dialysate and urine. We then studied 24 patients with renal failure, grouped with the 9 previous patients, to assess safety, rebound hyperkalemia, and patient outcome with this technique. RESULTS: In the first phase, 9 patients were administered 128 11 mmol of potassium in potassium-rich cardioplegia, and IHD removed 157 23 mmol. Urinary potassium excretion was only 10 3 mmol. Potassium removal occurred at a rate of 1.25 mmol/min with 0-mEq/L (mmol/L) potassium dialysate and a rate of 0.75 mmol/min with 3.0-mEq/L (mmol/L) potassium dialysate. In all 33 patients, successful initiation of cardiac rhythm occurred after cardiopulmonary bypass, and 5 patients had cardiac arrhythmias possibly from hypokalemia. In the next 24 hours, 5 dialysis-dependent patients developed hyperkalemia (potassium > 5.2 mEq/L [mmol/L]) requiring hemodialysis. Postoperative hemodialysis was delayed 2 to 3 days in the other patients. The overall death rate was 24% at 30 days. CONCLUSION: IHD effectively and safely removes potassium administered during potassium-rich cardioplegia during cardiopulmonary bypass in patients with renal failure and prevents postoperative hyperkalemia in the majority of patients. Overall mortality in patients with acute and chronic renal failure undergoing cardiac surgery is high irrespective of control of potassium balance in these patients.
Publication ISSN
0272-6386
Recommended Citation
Khoo MS, Braden GL, Deaton D, Owen S, Germain M, O'Shea M, Mulhern J, Rousou J, Flack J, Engleman R. Outcome and complications of intraoperative hemodialysis during cardiopulmonary bypass with potassium-rich cardioplegia. Am J Kidney Dis 2003 Jun;41(6):1247-56.