Is preoperative renal failure a significant risk factor in cardiac surgery patients?

We prospectively examined the impact of pre-existing renal failure (PERF) on the subsequent postop. course in cardiac surgery patients (pts). We studied all pts with PERF (preop. serum creatinine level > 1.7 mg %) who underwent open heart surgery from July 1993 to March 1995. Among 2617 pts of mean age 60.8+/-8.7 years, 98 pts (3.7%) had PERF. They were 86 males and 12 females, of mean (+/-SD) age 65.0 (+/-7.0) years. Patients underwent CABG surgery (N=66), valve replacement surgery (N=22), combined surgery (N=8) and other surgery (N=2). Acute on PERF developed 21 pts (21.4%). These pts developed a higher rate of postop. complications and had prolonged length of ICU and hospital stay compared to those who did not develop such a complication. However, there was not statistically significant difference in mortality rate between these two groups. Determinants for acute on PERF; were found to be perioperative and immediate postoperative development of shock, necessitating inotropic agents and IABP usage, prolonged bypass and aortic-cross clamp times and a higher rate of blood transfusions.