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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 3.850.86 and 3.110.89 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
VariableRenal FunctionPreoperativePostoperativeP value
With CPBS.Creatinine(mg/dl)1.48 0.551.920.750.0001
With CPBMDRDGFR(ml)51.729.3240.5114.89<0.0001
Without CPBS.Creatinine(mg/dl)1.410.431.620.44<0.0001
Without CPBMDRDGFR(ml)52.208.8149.68146.740.139

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