The Effects of Perfusion on Renal Function

The incidence of acute renal failure as a result of open heart surgery is difficult to quantify (Table 1). Some investigators are reporting this complication as any renal impairment following the surgical procedures in which case the incidence approaches 40%. 1 Others report only those cases which involve severe renal failure, occurring less than I 0%.25 The real importance, however, in the analysis of this data, is not the absolute incidence of this complication. Rather, the importance is that the mortality rate of patients with severe acute renal failure following open heart surgery approaches I 00%, even though this is a theoretically reversible complication and that aggressive medical management is available.5 In addition, the incidence of acute renal failure is likely to be on the increase due to the increase of the high risk surgical patient population. This paper will review foundational physiological principles regarding this complication and summarize a number of considerations for the perfusionist.