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Renal 

Chapter:
Renal
Author(s):

A Smith

, S Webb

, and S Allen

DOI:
10.1093/med/9780199209101.003.08
Page of

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date: 26 February 2020

Acute renal failure 126

Prevention 130

A practical approach to perioperative renal protection 134

Key points 135

Further reading 136

Acute renal failure (ARF) is a serious complication associated with considerable morbidity and mortality. Renal dysfunction after surgery is often associated with multiple organ dysfunction syndrome and may result in a mortality of up to 60%. It is also associated with a high risk of infection, prolonged intensive care unit (ICU) and hospital stay, progression to chronic renal failure (CRF), and dialysis-dependent end-stage renal disease (ESRD). The chance of full recovery from an episode of ARF in the surgical setting is low – many patients progress to develop varying degrees of chronic renal dysfunction. A large multicentre cohort study demonstrated that ARF requiring dialysis occurred in 1.1% of cardiac surgical patients and was associated with an operative mortality of 63.7%. This confirmed that ARF was an independent predictor of mortality, resulting in a 7.9-fold increase in risk of death....

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