Transitional bedside continuous renal replacement therapy for uremic patients after coronary artery bypass grafting

Objective To observe the therapeutic effects of bedside continuous renal replacement therapy (CRRT) after coronary artery bypass grafting (CABG) in uremic patients with coronary heart disease.Methods The data were collected from 28 uremic dialysis patients undergoing CABG from January 2008 to December 2016 in Xinhua Hospital Affiliated to Shanghai Jiao Tong University. Two of them underwent CABG under cardiopulmonary bypass, and the remaining 26 patients underwent CABG under off-pump. All of them were given the CRRT treatment to gradually convent to maintenance hemodialysis (MHD) treatment. Results All patients completed the surgery successfully, and CRRT was performed early after the surgery. The average first CRRT time was postoperative (18.6±5.4) h. Twenty-six patients underwent 3 times of CRRT before MHD treatment and 1 patient underwent 7 times of CRRT before MHD. One patient had failed during CRRT and died of multiple organ dysfunction on the 10th day after surgery. The average duration of CRRT was (7.8±5.4) days. The extubation time of the tracheal intubation was (3.8±3.3) days. The mean retention time of ICU was (8.8±4.3) days. Nine cases (32.1%) had the level of platelets below 60×10⁹/L. Postoperative pericardial and mediastinal drainage exceeded 500 mL in 5 cases and chest drainage exceeded 500 mL in 4 cases. Ten cases got atrial fibrillation and 3 cases got serious infection after surgery. Except 1 case of death, the remaining 27 patients were successfully transferred back to conventional MHD treatment.Conclusions Bedside CRRT is a safe and effective transitional approach to MHD treatment for dialysis patients undergoing CABG surgery.