End-stage of
chronic renal failure (CRF) is frequently associated with cardiac and vascular comorbidities requiring cardiosurgical interventions. Over 9 years, from 2000 to 2009, the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, delivered cardiosurgical care to 16 patients aged 20 to 74 years with end-stage CRF. The duration of programmed
hemodialysis was 1 to 102 months. The preoperative patient preparation protocol comprised correction of
anemia,
hypoproteinemia,
hypertension, and water-
electrolyte and
acid-base balances. Five patients underwent endovascular
myocardial revascularization; open heart surgery was performed in one patient. Interventions under
extracorporeal circulation were made in 10 other patients. Ultrafiltration was intraoperatively carried out. On-line
hemodiafiltration was performed following coronary artery stenting. After open operations,
renal replacement therapy (first
hemodiafiltration, then
hemodialysis) as daily sessions was initiated on day 2 and, when the patients were transferred to intensive care units, it was performed by the programmed
hemodialysis protocol. There were no fatal outcomes at the follow-up. The key aspects of treatment success achievement and improved quality of life in patients on programmed
hemodialysis are the detection of
cardiovascular diseases requiring surgery, the timely referral of the patients to a cardiosurgical hospital, the meticulous pre- and perioperative management (correction of
anemia,
hypoproteinemia, water-electrolyte balance, use of ultrafiltration and the adequate rate of perfusion at the stage of
extracorporeal circulation, and daily
renal replacement therapy in the postoperative period), and continuity in the work of all specialists.