Wijeysundera et al developed an index for predicting the need for renal replacement therapy for a patient who has undergone cardiac surgery. The authors are from the University of Toronto and University of Ottawa.
Parameters:
(1) preoperative estimated glomerular filtration rate (GFR) from eh Cockcroft and Gault equation (as an estimate of renal functional reserve).
(2) diabetes mellitus requiring medication
(3) left ventricular ejection fraction
(4) history of previous cardiac surgery
(5) type of cardiac surgery
(6) timing of procedure
(7) use of preoperative intra-aortic balloon pump (IABP)
|
Parameter |
Finding |
Points |
|
estimated GFR |
> 60 mL per minute |
0 |
|
|
31 to 60 mL per minute |
1 |
|
|
<= 30 mL per minute |
2 |
|
diabetes mellitus requiring therapy |
absent |
0 |
|
|
present |
1 |
|
left ventricular ejection fraction |
> 40% |
0 |
|
|
<= 40% |
1 |
|
history of previous cardiac surgery |
no |
0 |
|
|
yes |
1 |
|
type of cardiac surgery |
isolated coronary artery bypass graft (CABG) |
0 |
|
|
isolated atrial septal defect (ASD) repair |
0 |
|
|
other |
1 |
|
timing of the procedure |
elective |
0 |
|
|
urgent or emergency |
1 |
|
use of preoperative IABP |
no |
0 |
|
|
yes |
1 |
where:
• The GFR is not adjusted to body surface area.
index =
= SUM(points for all 7 parameters)
Interpretation:
• minimum index: 0
• maximum index: 8
• The higher the index the more likely the need for renal replacement therapy.
|
Index |
Risk Group |
Need for Renal Replacement Therapy |
|
0 or 1 |
low |
0.4% |
|
2 or 3 |
intermediate |
1-2% |
|
4 to 8 |
high |
10% |
Specialty: Anesthesiology, Nephrology
