Original Articles
Mannitol, furosemide, and dopamine infusion in postoperative renal failure complicating cardiac surgery

https://doi.org/10.1016/S0003-4975(99)01298-9Get rights and content

Abstract

Background. Acute renal failure occurring in the postoperative period, requiring dialysis after cardiac surgery is an important risk factor for an early mortality, and the overall mortality of this complication is as high as 40% to 60%. Dialysis in the early postoperative period is often complicated by acute hemodynamic, metabolic, and hematologic effects that adversely affect cardiopulmonary function in patients stabilizing from recent surgery. The purpose of this study was to avoid the need for dialysis by infusion of the solution of mannitol, furosemide, and dopamine in the early postoperative period in oliguric renal failure.

Methods. One hundred patients with postoperative oliguric or anuric renal failure despite adequate postoperative cardiac output and hemodynamic function were randomized. Forty patients (group A) were given intermittent doses of diuretics (furosemide, bumetadine, and ethracrynic acid) and fluids. Sixty patients (group B) were given continuous infusion of the solution of mannitol, furosemide, and dopamine; the infusion was started within 6 hours (mean 3.5 hours) in subgroup B1 (n = 30), and later than 6 hours (mean 7.5 hours) in subgroup B2 (n = 30) after the onset of renal failure.

Results. Diuresis occurred in 93.3% of group B (n = 56) versus 10% in group A (n = 4; patients with preop normal renal function). Ninety percent of group A (n = 36) required dialysis versus only 6.7% of group B (n = 4; patients with preexisting renal disease of subgroup B2). Renal function returned to preoperative normal (serum creatinine 0.9 ± 0.05, p < 0.0001) or baseline value (serum creatinine 2.5 ± 0.01, p < 0.0001) after first postoperative week in subgroup B1 and third postoperative week in subgroup B2.

Conclusions. Infusion of solution of mannitol, furosemide, and dopamine promoted diuresis in patients with acute postoperative renal failure with adequate postoperative cardiac output and had decreased the need for dialysis in the majority of patients. Early administration of this solution in acute renal failure caused early restoration of renal function to normal or baseline status. It remains to be determined whether routine administration of this solution in the early postoperative period for oliguric renal failure influences the long-term mortality and morbidity in those patients who do require dialysis.

Section snippets

Material and methods

At Newark Beth Israel Medical Center, during a period of four years, ie, from October 1994, to September 1998, an average of 730 operations per year were performed in adults for acquired cardiac disease. During this period, patients who manifested either acute oliguric or anuric renal failure in the postoperative period, with adequate postoperative cardiac output and tissue perfusion were prospectively evaluated and, in 100 patients, such acute renal dysfunction was recognized in the

Results

Preoperative patient characteristics, associated comorbid features, did not assume statistical significance between groups A and B, and patients had mean age of 71 years with moderately depressed left ventricular ejection fraction (EF 0.35). In patients with preoperative normal renal function (n = 56), the preoperative mean serum creatinine was 0.9 ± 0.03. In patients with preexisting renal disease (n = 44), the preoperative mean serum creatinine was 2.7 ± 0.03. After the onset of acute renal

Comment

The definition of acute postoperative renal failure varied from study to study. Although some define renal failure as a decrease in renal function that results in need for dialysis or a serum creatinine level of 2.5 mg% or more, in the present study and studies of others, it was defined as: (1) an increase in serum creatinine level of 0.5 mg/dL or more; (2) an increase of more than 50% over the baseline creatinine value; or (3) 50% or more decrease in calculated creatinine clearance 6, 7, 8, 9,

References (20)

There are more references available in the full text version of this article.

Cited by (114)

  • Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence

    2020, Journal of Cardiology
    Citation Excerpt :

    Therefore, fluid management with diuretics is a key factor for postoperative management following cardiovascular surgery, and it is common to administer intermittent doses of diuretics and fluids in the early postoperative stage as primary therapy. Loop diuretics are usually given as the first option, followed by an aldosterone blocker, mannitol, and human atrial natriuretic peptide (hANP) or recombinant human B-type natriuretic peptide infusion [5–9]. Those agents for diuresis have different mechanisms.

  • Risk Index for Postoperative Acute Kidney Injury After Valvular Surgery Using Cardiopulmonary Bypass

    2017, Annals of Thoracic Surgery
    Citation Excerpt :

    Therefore a shorter operation is desirable, especially in patients with a high risk score. The incidence of AKI necessitating dialysis after cardiac operations is relatively low (1% to 5%) [21–24]. Approximately 50% of patients with postoperative AKI in the present study required temporary or permanent hemodialysis, although the incidence of transition to permanent hemodialysis reported in the literature to date has been uncertain.

View all citing articles on Scopus
View full text