The Department of Intensive Nephrology performs scientific work to substantiate the choice of dialysis renal substitution therapy in patients with cardiac surgery with acute kidney damage or chronic kidney disease.
In 2016, kidney function disorders in the perioperative period were observed in half of cardiac patients. In one third of patients, renal dysfunction is already observed at the preoperative stage.
t has been established that renal dysfunction and its developmental moment with respect to cardiac surgical intervention are not risk factors for the death of cardiac surgery patients. The risk factors associated with hospital mortality in cardiac patients, both with renal function impairment and in patients with normal renal function, are SPON, sepsis, the need for adrenaline and norepinephrine.
There is no statistically significant difference in the duration of the postoperative period in cardiac surgery patients with or without renal impairment. The low frequency of renal function recovery during the postoperative period indicates that the 11-day postoperative period is not sufficient to restore the impaired renal function.
In 2017, it was found that the proposed new algorithm for the determination of indications for DNPT in cardiac surgery patients with renal dysfunction, which is more liberal from the point of view of diurnal diuresis and more conservative from the point of view of azotemia, compared with the most common approach to determining the indications for dialysis demonstrated statistically not a significant increase in hospital mortality (55.6% and 35.8%, respectively, p = 0.243) in cardiac surgery patients with renal impairment at the same frequency of DNPT (2.1% and 1.7%, response rates bottom, p = 0.56).
The connection between the degree of diuresis at the start of DNZT and the hospital mortality of cardiosurgical patients with renal impairment requires further study with a comprehensive approach to assessing the level of hydration, volness and pumping function of the heart of such patients, which directly affects both the level of diuresis and mortality among such patients.
The use of a comprehensive approach to determining the indications for cardio-surgical patients with DNPT, based on careful assessment of homeostasis, which can be adjusted by dialysis methods and the assessment of the balance of benefit and potential harm, is optimal in terms of cost of treatment and treatment outcomes.