Intraoperative surgical strategy changes in patients with chronic and end-stage renal disease undergoing coronary artery bypass grafting

2021 ◽  
Author(s):  
Ethan S Rosenfeld ◽  
Gregory D Trachiotis ◽  
Andrew D Sparks ◽  
Michael A Napolitano ◽  
K Benjamin Lee ◽  
...  
Keyword(s):  
Renal Function ◽  
Normal Renal Function ◽  
High Frequency ◽  
Artery Bypass ◽  
Surgical Strategy ◽  
High Frequency Ultrasound ◽  
Stage Renal Disease ◽  
End Stage ◽  
Strategy Changes ◽  
Frequency Ultrasound

Abstract OBJECTIVES Factors such as more diffuse atherosclerosis, plaque instability and accelerated vascular calcification in patients with chronic and end-stage renal disease (ESRD) can potentially present intraoperative challenges in coronary artery bypass grafting (CABG) procedures. We evaluated whether patients with chronic and ESRD experienced more surgical strategy changes and/or graft revisions than patients with normal renal function when undergoing CABG procedures according to a protocol for intraoperative high-frequency ultrasound and transit-time flow measurement (TTFM). METHODS Outcomes of CABG for patients with chronic and ESRD and patients with normal renal function enrolled in the multicentre prospective REQUEST (REgistry for QUality assESsmenT with Ultrasound Imaging and TTFM in Cardiac Bypass Surgery) study were compared retrospectively. The primary end point was frequency of intraoperative surgical strategy changes. The secondary end point was post-protamine TTFM parameters. RESULTS There were 95 patients with chronic and ESRD and 921 patients with normal renal function. Patients with chronic and ESRD undergoing CABG according to a protocol for intraoperative high-frequency ultrasound and TTFM had a higher rate of strategy changes overall [33.7% vs 24.3%; odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.01–2.48; P = 0.047] and greater revisions per graft (7.0% vs 3.4%; odds ratio = 2.14; 95% CI = 1.17–3.71; P = 0.008) compared to patients with normal renal function. Final post-protamine graft TTFM parameters were comparable between cohorts. CONCLUSIONS Patients with chronic and ESRD undergoing CABG procedures with high-frequency ultrasound and TTFM experience more surgical strategy changes than patients with normal renal function while achieving comparable graft flow. Clinical trial registration number: ClinicalTrials.gov NCT02385344

Elective Surgery in Patients with End Stage Renal Disease: What's the Risk?

2009 ◽  
Vol 75 (9) ◽  
pp. 790-793 ◽  
Author(s):  
Christopher R. Schneider ◽  
William Cobb ◽  
Shivani Patel ◽  
David Cull ◽  
Cass Anna ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Surgical Procedures ◽  
General Surgery ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Elective Surgical Procedures ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Little research has been performed in regards to the morbidity and outcomes associated with elective general surgery performed on patients with end stage renal disease (ESRD). With minimal data about the severity of disease in these patients, we sought to quantify the differences in the ESRD patient undergoing elective surgical procedures compared with matched controls. A review of all ESRD patients undergoing elective surgical procedures at a University Medical Center between 2001 and 2005 was performed. Outcomes included length of hospital stay, 1 year morbidity, and mortality. These patients were then compared with a control group with normal renal function matched 2:1. Fifty-two consecutive ESRD patients undergoing elective general surgery procedures were compared with 104 matched controls. The ESRD group experienced more complications (25 vs 16, P = 0.05) and had a larger number of overall complications compared with the controls (33 vs 19, P < 0.05). Length of stay was significantly longer in the ESRD group as well (8 vs 2.65 days, P < 0.0001). Incidence of death (4%) in the ESRD group was increased as well. Patients with ESRD require longer hospital stays and have an increased overall incidence and frequency of complications than patients with normal renal function undergoing elective general surgery procedures. The significantly increased morbidity should be considered when evaluating expected outcomes.

scholarly journals Pharmacokinetics of Telbivudine in Subjects with Various Degrees of Renal Impairment

2007 ◽  
Vol 51 (12) ◽  
pp. 4231-4235 ◽  
Author(s):  
Xiao-Jian Zhou ◽  
Suzanne Swan ◽  
William B. Smith ◽  
Thomas C. Marbury ◽  
Gloria Dubuc-Patrick ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Normal Renal Function ◽  
Severe Renal Impairment ◽  
Normal Function ◽  
Plasma Exposure ◽  
Mild Renal Impairment ◽  
Severe Impairment ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT This study evaluates the effect of renal impairment on the pharmacokinetics of telbivudine. Thirty-six subjects were assigned, on the basis of creatinine clearance (CLCR), to 1 of 5 renal function groups with 6 to 8 subjects per group: normal renal function; mild, moderate, or severe renal impairment; or end-stage renal disease [ESRD] requiring hemodialysis. Subjects received a single oral dose of telbivudine at 600 mg (normal function and mild impairment), 400 mg (moderate impairment), or 200 mg (severe impairment and ESRD); plasma and/or urine samples were collected over a 48-h period for pharmacokinetic analyses. Telbivudine was well tolerated by all subjects. The pharmacokinetics of 600 mg of telbivudine were comparable for subjects with mild renal impairment and normal renal function. Likewise, for subjects with moderate to severe impairment, including ESRD, reduced doses from 200 to 400 mg produced plasma exposure similar to that for subjects with normal renal function. These results indicate that the pharmacokinetics of telbivudine were dependent on renal function, especially for subjects with moderate to severe renal impairment or ESRD. Apparent total plasma clearance, renal clearance (CLR), and urinary excretion of telbivudine decreased as renal function deteriorated. A linear relationship was established between CLR and CLCR. In ESRD subjects, a routine 3.5- to 4-h hemodialysis session removed telbivudine from plasma at an extraction ratio of ∼45%, representing a ∼23% reduction in total exposure. These results suggest that while no adjustment of the telbivudine dose appears necessary for subjects with mild renal impairment, dose adjustment is warranted for those with moderate to severe renal impairment or ESRD in order to achieve optimal plasma exposure.

Long Term Follow-up of Recipients of Combined HLA-Matched Nonmyeloablative Bone Marrow and Kidney Transplantation for Multiple Myeloma with End-Stage Renal Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3368-3368
Author(s):  
Thomas R Spitzer ◽  
Megan Sykes ◽  
Nina Tolkoff Rubin ◽  
Tatsuo Kawai ◽  
Steven L McAfee ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Function ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Renal Allograft ◽  
Chronic Gvhd ◽  
Mixed Chimerism ◽  
Stage Renal Disease ◽  
End Stage

Abstract Abstract 3368 Poster Board III-256 Specific tolerance following combined kidney and bone marrow transplantation (Kd/BMT)for patients with end stage renal disease (ESRD) with or without an underlying malignancy has been accomplished, as evidenced by prolonged normal renal function without ongoing immunosuppression (IS)and the demonstration of in vitro donor specific hyporesponsiveness (N Engl J Med 2008; 358:353-361; Am J Transplant 2006;6:2121-2133). In order to achieve potent anti-myeloma responses and induce tolerance through the induction of mixed chimerism (MC) for the renal allograft, 7 patients (median age 48 (34-55) yrs with multiple myeloma (MM) and ESRD received a combined HLA-matched Kd/BMT, with longest follow-up time of almost 11 years. An eighth pt developed cyclophosphamide (CY) cardiotoxicity on day -5 and did not receive a transplant. Preparative therapy for the transplants consisted of CY 60 mg/kg (days -5, -4) with hemodialysis 14 hrs after each CY dose, equine anti-thymocyte globulin, 15-20 mg/kg on days -1, +1, +3, and +5 and thymic irradiation (700 cGy) on day -1. Cyclosporine (CSP) was begun on day -1, with combined Kd/BMT on day 0. Nine additional donor lymphocyte infusions were given to 5 pts (5 for chimerism conversion, 4 for persistent/progressive disease (PD)). Acute (A) and chronic (C) GVHD developed in one patient following DLI for early PD, while chronic GVHD developed in two pts (one after a second stem cell transplant). Characteristics and outcomes of the 7 combined Kd/BMT recipients are as follows: # after 2nd transplant (myeloablative) from the same donor ; FDC: full donor chimerism In summary, 5 of 7 pts are alive, 4 without evidence of MM from 2.7 to 10.9 yrs post-Kd /BMT. Three pts have normal renal function without IS, while two pts have normal renal function on IS for chronic GVHD. Sustained renal allograft tolerance and prolonged anti-myeloma responses are achievable following nonmyeloablative HLA-matched kidney and BMT and the induction of mixed chimerism. This study was supported by the Immune Tolerance Network, National Institute of Allergy and Infectious Diseases. Disclosures: Off Label Use: Equine anti-thymocyte globulin: in vivo T cell depletion Cyclophosphamide:conditioning therapy for transplantation.

scholarly journals Efficacy and Safety of Sugammadex for the Reversal of Rocuronium-Induced Neuromuscular Blockade in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1259
Author(s):  
Young-Sung Kim ◽  
Byung-Gun Lim ◽  
Young-Ju Won ◽  
Seok-Kyeong Oh ◽  
Jung-Suk Oh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Function ◽  
Renal Disease ◽  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background and Objectives: Sugammadex is widely used in anesthesia to reverse rocuronium-induced neuromuscular blockade (NMB). In patients with compromised kidney function, most drugs show alteration of their pharmacokinetic profile with reduced clearance. The purpose of this article is to examine the efficacy, pharmacokinetics, and safety of sugammadex in end-stage renal disease (ESRD) patients receiving general anesthesia, using a systematic review. Materials and Methods: The databases of PubMed, EMBASE, the Cochrane Library, Web of Science, Scopus, KoreaMed, and ClinicalTrials.gov were searched for studies comparing the efficacy or safety outcomes of sugammadex administration for the reversal of rocuronium-induced NMB, in ESRD patients (group R) or in those with normal renal function (group N) undergoing surgery under general anesthesia. Results: We identified nine studies with 655 patients—six prospective, case-control studies with 179 patients (89 and 90 in groups R and N) and three retrospective observational studies with 476 ESRD patients. In the six prospective studies, the times taken to reach a train-of-four ratio ≥0.9, 0.8, and 0.7 were significantly longer in group R than in group N (weighted mean difference [95% confidence interval] [min]: 1.14 [0.29 to 2.00], 0.9 [0.24 to 1.57], 0.89 [0.20 to 1.57], respectively). The total plasma clearance of sugammadex was significantly lower in group R than in group N. There was no significant difference in the incidence of NMB recurrence and prolonged time to recovery between the groups. In the three retrospective studies, the possibility of sugammadex-related adverse events appears to be insignificant. Conclusions: Sugammadex may effectively and safely reverse rocuronium-induced NMB in patients with ESRD, although the recovery to a TOF ratio of 0.9 may be prolonged compared to patients with normal renal function. Further studies are needed, considering the small number of studies included and the high heterogeneity of some of the results.

Evaluation of Induction Doses of Propofol: Comparison between Endstage Renal Disease and Normal Renal Function Patients

2002 ◽  
Vol 30 (5) ◽  
pp. 584-587 ◽  
Author(s):  
P. Goyal ◽  
G. D. Puri ◽  
C. K. Pandey ◽  
S. Srivastva
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Renal Disease ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Objective Assessment ◽  
Haemoglobin Concentration ◽  
End Point ◽  
Stage Renal Disease ◽  
End Stage

Anaemia, hypoproteinaemia and acidic pH in renal failure patients can alter the pharmacokinetics and pharmaco-dynamics of anaesthetic agents, resulting in altered dose requirements. We evaluated the induction dose of propofol in adult patients with end-stage renal disease by titrating the hypnotic effect by means of a clinical parameter as well as using a more objective assessment of hypnosis, the Bispectral Index (BIS) monitor. The dose was compared with that for patients with normal renal function. Propofol doses that provided the clinical end-point of hypnosis (syringe drop method), as well as the end-point of a mean (SD) BIS value of 50 (5), were evaluated in 27 end-stage renal disease and 27 normal renal function patients. Propofol was administered at 0.2mg/kg every 15 seconds until these end-points were achieved. End-stage renal disease patients required significantly higher propofol doses to achieve the clinical end-point of hypnosis (1.42 (0.24) mg/kg versus 0.89 (0.2) mg/kg in normal renal function patients, P<0.05 unpaired “t” test). Propofol dose required to achieve a BIS of 50 (5) was also higher in end-stage renal disease patients (2.03 (0.4) mg/kg versus 1.39 (0.43) mg/kg in normal renal function patients, P<0.05). There was a significant negative correlation of propofol dose with preoperative haemoglobin concentration. A hyperdynamic circulation in renal failure patients with anaemia may be responsible for the higher propofol dose requirement in this group.

scholarly journals High Detection Rate and Risk Factors of Melanosis Coli in End-Stage Renal Disease Patients Awaiting Kidney Transplantation: A Single-Center Retrospective Study in China

2020 ◽  
Author(s):  
Wu-Xing Zhang ◽  
Wei Zhou ◽  
Yang Li ◽  
Yang Wang ◽  
Wei Huang
Keyword(s):  
Renal Function ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Detection Rate ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression ◽  
Melanosis Coli ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background. Rhubarb-containing Traditional Chinese Medicine (TCM) is widely used to manage chronic renal failure in China. Studies show that anthranoids contained in rhubarb are related to the occurrence of melanosis coli (MC). However, no study on the detection rate of MC in end-stage renal disease (ESRD) patients in China has been reported.Methods. We conducted a retrospective study on 99 ESRD patients who received a colonoscopy as part of pre-transplant work-up between Jan 1, 2017 and July 1, 2020 in a single center in Beijing, China. 200 age- and gender-matched subjects with normal renal function and received a colonoscopy for health screening in the same period were randomly selected as control group. The detection rate of MC in ESRD patients and control subjects was calculated and compared. Univariate analysis and multivariate logistic regression were performed in succession to determine the association between ESRD and MC, and also probe the independent MC risk factors in ESRD patients.Results. Among the 99 ESRD patients, MC was detected in 19, with a detection rate of 19.2% (95% confidence interval [CI]: 11.3%, 27.1%). In contrast, among 200 control subjects with normal renal function, MC was only detected in 1 subject, with an detection rate of 0.5% (95%CI: 0.5%, 1.5%) (ESRD vs. control: odds ratio [OR] = 47.263, 95% CI: 6.222, 358.981; p = 0.000). After adjustment of age, body mass index(BMI), albumin, hemoglobin and Charlson comorbidity index, being ESRD was still associated with the presence of MC (Odds ratio[95%CI]: 36.251[3.435, 382.559], p = 0.003). In ESRD patients, both univariate analysis (OR = 4.358, 95% CI: 1.329, 14.286; p = 0.012) and multivariate logistic regression (OR = 4.916, 95% CI: 1.462, 16.525, p = 0.010) found that past use of Rhubarb-containing TCM was the only independent risk factor of MC.Conclusion. The prevalence of MC in this cohort of ESRD patients was 19.2%, which was significantly higher than that of control with normal renal function. Past use of Rhubarb-containing traditional Chinese herbs was the only independent risk factor for the detection of MC in these ESRD patients. Our work highlights firstly that when prescribing Rhubarb-containing TCM to ESRD patients, the risk of MC development should be alerted, and also there is a need for arranging high quality, well-designed studies to examine the prevalence, etiology, impact, management and prognosis of MC in ESRD patients, especially those awaiting kidney transplantation.

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