Perioperative renal failure: hypoperfusion during cardiopulmonary bypass?

Semin Cardiothorac Vasc Anesth. 2007 Dec;11(4):265-8. doi: 10.1177/1089253207311141.


Acute renal failure is one of the most frequent and life-threatening complications after cardiac surgery. There is a recent growing deal of information suggesting that during the time of cardiopulmonary bypass kidneys may suffer from an imbalance between oxygen supply and oxygen needs. A low hematocrit during cardiopulmonary bypass is associated with an increase risk of acute renal failure, mainly due to a low oxygen delivery. An inadequate oxygen delivery during cardiopulmonary bypass is associated with lactate production, and under normothermic conditions, hyperlactatemia appears for an oxygen delivery below 260 mL min(-1) m(-2). The risk of acute renal failure significantly increases for an oxygen delivery approximately at the same value (272 mL min(-1) m(- 2)). During cardiopulmonary bypass, the pump flow should be coupled with the hematocrit to avoid falling below this critical oxygen delivery.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / etiology*
  • Cardiopulmonary Bypass / adverse effects*
  • Hematocrit
  • Humans
  • Intraoperative Complications*
  • Kidney / metabolism
  • Kidney / pathology
  • Lactic Acid / blood
  • Oxygen / administration & dosage*
  • Oxygen / metabolism
  • Risk Factors


  • Lactic Acid
  • Oxygen