Does intensive perioperative dialysis improve the results of coronary artery bypass grafting in haemodialysed patients?

Background. Between January 1996 and April 1998, 17 chronic haemodialysed p atients underwent coronary artery bypass grafting (CABG). Two of them simul taneously had valve replacement. Methods. Except for two cases in which CABG was performed in an emergency, 15 patients (CRF group) received 3 consecutive days of haemodialysis in the preoperative period, intraoperative haemodialysis connected to cardiac pul monary bypass (CPB) and continuous hemodiafiltration in the early postopera tive period. The perioperative clinical parameters of the CRF group were co mpared with those of 17 age-matched patients with normal renal function und ergoing CABG as the control (NRF group). Results. When the perioperative variables were compared, no significant dif ferences were seen in total operation time and CPB time, but we noted signi ficant increases in the mean volume of transfused blood in the 6 perioperat ive days, postoperative intubation time, postoperative fasting time, and ti me spent in the intensive care unit. Levels of central venous pressure, sys tolic blood pressure, respiratory index (PaO2/FiO(2)) and daily fluid balan ce of the CRF group were the same as the control group in the early postope rative period. In addition, the levels of serum creatinine, urea nitrogen, potassium and hematocrit of CRF group remained almost constant in the early postoperative period. After all, the hospital morbidity of the CRF group w as not more serious than that of the NRF group, and hospital mortality of t he CRF and NRF groups was 0%. Conclusions. Our intensive perioperative dialysis programme could successfu lly manage the perioperative clinical course of haemodialysed patients unde rgoing CABG.