Coronary Artery Bypass Grafting With Or Without Cardiopulmonary Bypass In Patients With Preoperative Non Dialysis Dependent Renal Insufficiency : A Randomized Study
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Objective: Preoperative renal insufficiency is a predictor of acute renal failure in patients undergoing coronary artery revascularization using cardiopulmonary bypass. Off-pump coronary artery bypass grafting (CABG) has been shown to be less deleterious than on-pump CABG in patients with normal renal function, but the effect of this technique in patients with non-dialysis dependent renal insufficiency in a randomized study is unknown.
Methods: From August 2004 through October 2005, 116 consecutive patients with preoperative non-dialysis dependent renal insufficiency (glomerular filtration rate measured using modified diet in renal disease formula (MDRDGFR) ≤60ml) undergoing primary CABG were randomized to on-pump (n=60) and off-pump (n=56) groups. MDRDGFR, serum Creatinine levels were measured preoperatively and postoperatively at days 1and5. The changes in renal function and clinical outcomes were compared between two groups.
Results: Preoperative characteristics were comparable between the two groups. Mean number of grafts per patient was 3.85±0.86 and 3.11±0.89 in on-pump and off-pump groups respectively (p<0.0001). The postoperative renal function as assessed by GFR measurement is significantly worsened in the on-pump group compared to off-pump group as shown in table 1. Although there is no difference in the degree of fall in GFR between diabetics and non-diabetics of on-pump group, the rise in s.creatinine on first post-operative day in diabetics is more pronounced than in non-diabetics (p 0.003). There is no significant difference in mortality (p 0.09) and incidence of stroke (p=0.332) between the groups but there was significant increase in blood loss and requirement of blood transfusion (both p<0.0001) in on-pump group.
Conclusion: This study suggests that on-pump CABG as compared to off-pump CABG is more deleterious to renal function in diabetic patients with non-dialysis dependent renal insufficiency.Table 1| Variable | Renal Function | Preoperative | Postoperative | P value |
| With CPB | S.Creatinine(mg/dl) | 1.48 ± 0.55 | 1.92±0.75 | 0.0001 |
| With CPB | MDRDGFR(ml) | 51.72±9.32 | 40.51±14.89 | <0.0001 |
| Without CPB | S.Creatinine(mg/dl) | 1.41±0.43 | 1.62±0.44 | <0.0001 |
| Without CPB | MDRDGFR(ml) | 52.20±8.81 | 49.68±146.74 | 0.139 |
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