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Acute Renal Failure Following Coronary Artery By-Pass Surgery: Perioperative Risk Factors

Year 2009, Volume: 12 Issue: 1, 10 - 17, 01.01.2008

Mustafa Saçar Gökhan Önem Yal›n Tolga Yaylal› İbrahim Susam Fahri Adal› Ahmet Baltalarl›

Abstract

Objective: Morbidity and mortality rates due to acute renal failure (ARF) developed in the postoperative period in patients undergoing coronary artery by-pass surgery (CABG), are increasing. After the determination of risk factors for the development of ARF in the perioperative period, treatment strategies to prevent the development of ARF can be implemented. Methods: Three hundred and nine patients who had undergone isolated CABG between May 2005 and December 2006 were included in the study. Patients' data registered in the preoperative, intra-operative, and postoperative periods were collected in the electronic media. Factors possibly affecting the development of ARF in the postoperative period were determined by univariate analysis. Later, the independent risk factors affecting the development of ARF were determined by multivariate analysis. Results: Univariate analysis showed that there was a relation between old age, low ejection fraction (EF) in the preoperative period, presence of COPD, high preoperative serum creatinine levels, long CPB duration, the requirement of intra-operative inotropic support, the amount of postoperative mediastinal drainage, peak creatinine levels, the amount of blood transfusions and postoperative ARF development. At the end of the evaluation of these factors with multivariate analysis; old age, high creatinine levels in the preoperative period, the requirement of inotropic support during the operation and increased amounts of postoperative mediastinal drainage were found to be independent risk factors for the development of ARF. Conclusions: ARF development is found to be higher in patients with old age, low EF, impaired preoperative renal functions. We suggest that implementing a close follow up with appropriate measures for these patients can decrease the risk of ARF development postoperatively.

Keywords

Coronary artery bypass surgery acute renal failure ICU

References

  • Leacche M, Rawn JD, Mihaljevic T, Lin J, Karavas AN, Paul S, Byrne JG. Outcomes in patients with normal se- rum creatinine and with artificial renal support for acute renal failure developing after coronary artery bypass grafting. Am J Cardiol 2004;93:353356.
  • Mangano CM, Diamondstone LS, Ramsay JG, Aggar- wal A, Herskowitz A, Mangano D. Renal dysfunction af- ter myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Ann Intern Med 1998;128:194203.
  • Zanardo G, Michielon P, Paccagnella A, Rosi P, Calo M, Salandin V, Da Ros A, Michieletto F, Simini G. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Tho- rac Cardiovasc Surg 1994;107:14891495.
  • Ostermann ME, Taube D, Morgan CJ, Evans TW. Acu- te renal failure following cardiopulmonary bypass: a changing picture. Intens Care Med 2000;26:565571.
  • Nashef SA, Roques F, Michel P, Cortina J, Faichney A, Gams E, Harjula A, Jones MT. Coronary surgery in Euro- pe: comparison of the national subsets of the European system for cardiac operative risk evaluation database. Eur J CardioThorac Surg. 2000;17:396399.
  • Alexander KP, Anstrom KJ, Muhlbaier LH, Grosswald RD, Smith PK, Jones RH, Peterson ED. Outcomes of car- diac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J Am Coll Cardiol. 2000;35:731738.
  • Rao V, Weisel RD, Buth KJ, Cohen G, Borger MA, Shiono N, Bhatnagar G, Fremes SE, Goldman BS, Chris- takis GT. Coronary artery bypass grafting in patients with nondialysisdependent renalinsufficiency. Circulation 1997;96:3845.
  • Corwin HL, Sprague SM, DeLaria GA, Norusis MJ. Acute renal failure associated with cardiac operations. A case control study. J Thorac Cardiovasc Surg 1989;98:110712.
  • Provenchère S, Plantefève G, Hufnagel G, Vicaut E, De Vaumas C, Lecharny JB, Depoix JP, Vrtovsnik F, Des- monts JM, Philip I. Renal dysfunction after cardiac sur- gery with normothermic cardiopulmonary bypass: inci- dence, risk factors, and effect on clinical outcome. Anesth Analg. 2003;96:125864.
  • Endre ZH. Post cardiac surgery acute renal failure in the 1990’s. Aust NZ J Med. 1995;25:278279.
  • Conger JD. Indepth review: interventions in clinical acute renal failure: What arethe data? Am J Kidney Dis 1995;26:565576.
  • Chertow G, Lazarus JM, Hristiansen CL, Cook EF, Hammermeister KE, Grover F, Daley J. Preoperative re- nal risk stratification. Circulation 1997;97:878—884.
  • Conlon PJ, StaffordSmith M, White WD, Newman MF, King S, Winn MP. Acute renal failure following cardi- ac surgery. Nephrol Dial Transplant 1999;14:11581162.
  • Romao EJ,Fuzissima MG,Vidonho AF, Noronha IL, Quintaes PSL, Abensur H, Araujo MRT, Freita I, Marcon- des M. Outcome of acute renal failure associated with cardiac surgery in infants. Arq Bras Cardiol 2000;75:318321.
  • Shaw NJ, Blockenbank JT, Dickinson DF, Wilson N, Walker DR. Longterm outcome for children with acute renal failure following cardiac surgery. Int J Cardiol 1991;31:1616.
  • Zobel G, Stein J, Kutting M, Beitzke A, Metzler H, Rigler B. Continuous extracorporeal fluid removal in
  • children with low cardiac output after cardiac operati- ons. J Thorac Cardiovasc Surg 1991;101:5937.
  • Bellomo R, Kellum J, Ronco C. Acute renal failure: Ti- me for consensus. Intensive Care Med 2001;27:16851688. 1188.. Solomon R, Werner C, Mann D, D'Elia J, Silva P. Ef- fects of saline, mannitol and furosemide to prevent acu- te decreases in renal function induced by radiocontrast agents. New England Journal of Medicine 1994;331:1410–1420.
  • Moore RD, Smith CR, Lipsky JJ, Mellits ED, Lietman PS. Risk factors for nephrotoxicity in patients treated with aminoglycosides. Ann Intern Med 1984;100:352357. 2200.. Turney J. Acute renal failure: a dangerous condition. JAMA 1996;275:15161517.
  • Lawman SH, Cohen SL, Batson SD: Acute renal failu- re after cardiothoracic surgery: A review of three years experience. Blood Purif 2002;20:293295.
  • Lameire N, Hoste E, Van Loo A, Dhondt A, Bernaert P, Vanholder R. Pathophysiology, causesand prognosis of acute renal failure in the very old. Madrid Acute RE- NAL Failure Study Group. J Am Geriatr Soc 1998;46:721725.
  • Val Den Noortgate N, Mount V, Lamot C, Van Nooten G, Dhondt A, Vanholder R, Afschrift M, Lamiere N.
  • Outcome in a postcardiac surgery population with acute renal failure requiring dialysis: does age make a differen- ce? Nephrol Dial Transplant 2003;18:732736.
  • Durmaz I, Buket S, Atay Y, Yagdi T, Ozbaran M, Bo- ga M, Alat I, Guzelant A, Basarir S. Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure. J Thorac Cardiovasc Surg 1999; 118:306315.
  • Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M. Minimal changes of serum creatinine predict prognosis in patients after car- diothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004;15:1597–1605.
  • Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality. A cohort analysis. JAMA 1996;275:14891494.
  • Boldt J, Brenner T, Lehmann A, Suttner SW, Kumle B, Isgro F. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg 2003;75:906912.
  • Kaplan JA, Reich DL, Konstadt SN. Cardiac Anesthe- sia. 4th ed. PH?LADELPH?. Pa:WB Saunders Co; 1999:10741075.
  • Antunes P, Prieto D, De Oliveira JF, Antunes M. Re- nal dysfunction after myocardial revascularization. Eur J Cardiothorac Surg 2004;25:597604.
  • Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. Onpump vs. offpump coronary revasculari- zation: evaluation of renalfunction. Ann Thorac Surg 1999;68:4938.
  • De Moreas Lobo EM, Burdmann EA, Abdulkader RC. Renal function changes after elective cardiac surgery with cardiopulmonary bypass. Renal Failure 2000;22:48797.
  • Gu YJ, de Vries AJ, Boonstra PW, Van Oeveren W. Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac sur- gery. J Thorac Cardiovasc Surg 1996;112:494500.
  • Verrier DE, Boyle EM. Endothelial cell injury in cardi- ovascular surgery. Ann Thorac Surg 1996;62:915922.
  • Piriou V, Claudel JP, Bastien O, Ross S, Lehot JJ. Se- vere systemic cholesterol embolisation after open heart surgery. Br J Anaesth 1996;77:277–280.
  • Hilberman M, Derby GC, Spencer RJ, Stinson EB. Se- quential pathophysiological changes characterizing the progression from renal dysfunction to acute renal failure following cardiac operation. J Thorac Cardiovasc Surg 1980;97:838844.
  • Lin CL, Pan KY, Hsu PY, Yang HY, Guo HL, Huang CC. Preoperative 24hour urine amount as an indepen- dent predictor of renal outcome in poor cardiac function patients after coronary artery bypass grafting. J Crit Ca- re 2004;19:9298.
  • Marik PE, Sibbald WJ., Effect of storedblood transfu- sion on oxygen delivery in patients with sepsis. JAMA 1993;269:30249
  • Loef BG, Epema AH, Smilde TB, Henning RH, Ebels T, Navis G, Stegeman CA. Immediate postoperative renal function deterioration in cardiac surgical patients pre- dicts inhospital mortality and longterm survival. J Am Soc Nephrol 2005;16:195200.
  • Brown JR, Cochran RP, Dacey LJ, Ross CS, Kunzel- man KS, Dunton RF, Braxton JH, Charlesworth DC, Clo- ugh RA, Helm RE, Leavitt BJ, Mackenzie TA, O’Connor GT. Perioperative increases in serum creatinine are pre- dictive of increased 90day mortality after coronary artery bypass graft surgery. Circulation 2006;114:I40913.

Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri

Year 2009, Volume: 12 Issue: 1, 10 - 17, 01.01.2008

Mustafa Saçar Gökhan Önem Yal›n Tolga Yaylal› İbrahim Susam Fahri Adal› Ahmet Baltalarl›

Abstract

Amaç: Koroner Baypas cerrahisi sonras›nda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l› olarak mortalite ve morbidite oran› giderek art›fl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: May›s 2005 – Aral›k 2006 tarihleri aras›nda izole koroner baypas cerrahisi uygulanan 309 hasta çal›flmaya dahil edildi. Operasyon öncesindeki, operasyon esnas›ndaki ve operasyon sonras›ndaki hasta verileri bilgisayar kay›t sistemi ile topland›. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand›. Ard›ndan ABY geliflimine neden olabilecek ba¤›ms›z risk faktörleri multivaryans analiz ile belirlendi. Bulgular: Univaryans analiz sonucunda ileri yafl, ameliyat öncesindeki düflük ejeksiyon fraksiyonu, KOAH varl›¤›, serum kreatinin yüksekli¤i, Kardiyopulmoner baypas süresinin uzamas›, ameliyat esnas›nda Amaç: Koroner Baypas cerrahisi sonras›nda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l› olarak mortalite ve morbidite oran› giderek art›fl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: May›s 2005 – Aral›k 2006 tarihleri aras›nda izole koroner baypas cerrahisi uygulanan 309 hasta çal›flmaya dahil edildi. Operasyon öncesindeki, operasyon esnas›ndaki ve operasyon sonras›ndaki hasta verileri bilgisayar kay›t sistemi ile topland›. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand›. Ard›ndan ABY geliflimine neden olabilecek ba¤›ms›z risk faktörleri multivaryans analiz ile belirlendi. Bulgular: Univaryans analiz sonucunda ileri yafl, ameliyat öncesindeki düflük ejeksiyon fraksiyonu, KOAH varl›¤›, serum kreatinin yüksekli¤i, Kardiyopulmoner baypas süresinin uzamas›, ameliyat esnas›nda Amaç: Koroner Baypas cerrahisi sonras›nda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l› olarak mortalite ve morbidite oran› giderek art›fl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: May›s 2005 – Aral›k 2006 tarihleri aras›nda izole koroner baypas cerrahisi uygulanan 309 hasta çal›flmaya dahil edildi. Operasyon öncesindeki, operasyon esnas›ndaki ve operasyon sonras›ndaki hasta verileri bilgisayar kay›t sistemi ile topland›. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand›. Ard›ndan ABY geliflimine neden olabilecek ba¤›ms›z risk faktörleri multivaryans analiz ile belirlendi. Bulgular: Univaryans analiz sonucunda ileri yafl, ameliyat öncesindeki düflük ejeksiyon fraksiyonu, KOAH varl›¤›, serum kreatinin yüksekli¤i, Kardiyopulmoner baypas süresinin uzamas›, ameliyat esnas›nda inotropik destek gereksinimi, ameliyat sonras›nda mediastinal drenaj miktar›, pik kreatinin seviyesi, kan transfüzyon miktar› ile postoperative ABY geliflimi iliflkili bulunmufltur. Bu faktörlerin multivaryans analiz ile de¤erlendirilmeleri sonucunda ileri yafl, operasyon öncesindeki yüksek kreatinin düzeyi, ameliyat esnas›ndaki inotropik destek gereksinimi ve ameliyat sonras›nda mediastinal drenaj miktar› ABY gelifliminde ba¤›ms›z risk faktörleri olarak belirlendi. Sonuç: Operasyon öncesinde renal foksiyonlar› s›n›rda olan, ileri yafltaki ve düflük ejeksiyon fraksiyonu olan hastalarda ABY geliflimi daha s›k görülmektedir. Bu hastalarda uygun destek tedavileri ile ABY gelifliminin önüne geçilebilece¤ini düflünüyoruz.

Keywords

Koroner arter baypas cerrahisi Akut böbrek yetmezli¤i Yo¤un bak›m ünitesi

References

  • Leacche M, Rawn JD, Mihaljevic T, Lin J, Karavas AN, Paul S, Byrne JG. Outcomes in patients with normal se- rum creatinine and with artificial renal support for acute renal failure developing after coronary artery bypass grafting. Am J Cardiol 2004;93:353356.
  • Mangano CM, Diamondstone LS, Ramsay JG, Aggar- wal A, Herskowitz A, Mangano D. Renal dysfunction af- ter myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Ann Intern Med 1998;128:194203.
  • Zanardo G, Michielon P, Paccagnella A, Rosi P, Calo M, Salandin V, Da Ros A, Michieletto F, Simini G. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Tho- rac Cardiovasc Surg 1994;107:14891495.
  • Ostermann ME, Taube D, Morgan CJ, Evans TW. Acu- te renal failure following cardiopulmonary bypass: a changing picture. Intens Care Med 2000;26:565571.
  • Nashef SA, Roques F, Michel P, Cortina J, Faichney A, Gams E, Harjula A, Jones MT. Coronary surgery in Euro- pe: comparison of the national subsets of the European system for cardiac operative risk evaluation database. Eur J CardioThorac Surg. 2000;17:396399.
  • Alexander KP, Anstrom KJ, Muhlbaier LH, Grosswald RD, Smith PK, Jones RH, Peterson ED. Outcomes of car- diac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J Am Coll Cardiol. 2000;35:731738.
  • Rao V, Weisel RD, Buth KJ, Cohen G, Borger MA, Shiono N, Bhatnagar G, Fremes SE, Goldman BS, Chris- takis GT. Coronary artery bypass grafting in patients with nondialysisdependent renalinsufficiency. Circulation 1997;96:3845.
  • Corwin HL, Sprague SM, DeLaria GA, Norusis MJ. Acute renal failure associated with cardiac operations. A case control study. J Thorac Cardiovasc Surg 1989;98:110712.
  • Provenchère S, Plantefève G, Hufnagel G, Vicaut E, De Vaumas C, Lecharny JB, Depoix JP, Vrtovsnik F, Des- monts JM, Philip I. Renal dysfunction after cardiac sur- gery with normothermic cardiopulmonary bypass: inci- dence, risk factors, and effect on clinical outcome. Anesth Analg. 2003;96:125864.
  • Endre ZH. Post cardiac surgery acute renal failure in the 1990’s. Aust NZ J Med. 1995;25:278279.
  • Conger JD. Indepth review: interventions in clinical acute renal failure: What arethe data? Am J Kidney Dis 1995;26:565576.
  • Chertow G, Lazarus JM, Hristiansen CL, Cook EF, Hammermeister KE, Grover F, Daley J. Preoperative re- nal risk stratification. Circulation 1997;97:878—884.
  • Conlon PJ, StaffordSmith M, White WD, Newman MF, King S, Winn MP. Acute renal failure following cardi- ac surgery. Nephrol Dial Transplant 1999;14:11581162.
  • Romao EJ,Fuzissima MG,Vidonho AF, Noronha IL, Quintaes PSL, Abensur H, Araujo MRT, Freita I, Marcon- des M. Outcome of acute renal failure associated with cardiac surgery in infants. Arq Bras Cardiol 2000;75:318321.
  • Shaw NJ, Blockenbank JT, Dickinson DF, Wilson N, Walker DR. Longterm outcome for children with acute renal failure following cardiac surgery. Int J Cardiol 1991;31:1616.
  • Zobel G, Stein J, Kutting M, Beitzke A, Metzler H, Rigler B. Continuous extracorporeal fluid removal in
  • children with low cardiac output after cardiac operati- ons. J Thorac Cardiovasc Surg 1991;101:5937.
  • Bellomo R, Kellum J, Ronco C. Acute renal failure: Ti- me for consensus. Intensive Care Med 2001;27:16851688. 1188.. Solomon R, Werner C, Mann D, D'Elia J, Silva P. Ef- fects of saline, mannitol and furosemide to prevent acu- te decreases in renal function induced by radiocontrast agents. New England Journal of Medicine 1994;331:1410–1420.
  • Moore RD, Smith CR, Lipsky JJ, Mellits ED, Lietman PS. Risk factors for nephrotoxicity in patients treated with aminoglycosides. Ann Intern Med 1984;100:352357. 2200.. Turney J. Acute renal failure: a dangerous condition. JAMA 1996;275:15161517.
  • Lawman SH, Cohen SL, Batson SD: Acute renal failu- re after cardiothoracic surgery: A review of three years experience. Blood Purif 2002;20:293295.
  • Lameire N, Hoste E, Van Loo A, Dhondt A, Bernaert P, Vanholder R. Pathophysiology, causesand prognosis of acute renal failure in the very old. Madrid Acute RE- NAL Failure Study Group. J Am Geriatr Soc 1998;46:721725.
  • Val Den Noortgate N, Mount V, Lamot C, Van Nooten G, Dhondt A, Vanholder R, Afschrift M, Lamiere N.
  • Outcome in a postcardiac surgery population with acute renal failure requiring dialysis: does age make a differen- ce? Nephrol Dial Transplant 2003;18:732736.
  • Durmaz I, Buket S, Atay Y, Yagdi T, Ozbaran M, Bo- ga M, Alat I, Guzelant A, Basarir S. Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure. J Thorac Cardiovasc Surg 1999; 118:306315.
  • Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M. Minimal changes of serum creatinine predict prognosis in patients after car- diothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004;15:1597–1605.
  • Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality. A cohort analysis. JAMA 1996;275:14891494.
  • Boldt J, Brenner T, Lehmann A, Suttner SW, Kumle B, Isgro F. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg 2003;75:906912.
  • Kaplan JA, Reich DL, Konstadt SN. Cardiac Anesthe- sia. 4th ed. PH?LADELPH?. Pa:WB Saunders Co; 1999:10741075.
  • Antunes P, Prieto D, De Oliveira JF, Antunes M. Re- nal dysfunction after myocardial revascularization. Eur J Cardiothorac Surg 2004;25:597604.
  • Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. Onpump vs. offpump coronary revasculari- zation: evaluation of renalfunction. Ann Thorac Surg 1999;68:4938.
  • De Moreas Lobo EM, Burdmann EA, Abdulkader RC. Renal function changes after elective cardiac surgery with cardiopulmonary bypass. Renal Failure 2000;22:48797.
  • Gu YJ, de Vries AJ, Boonstra PW, Van Oeveren W. Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac sur- gery. J Thorac Cardiovasc Surg 1996;112:494500.
  • Verrier DE, Boyle EM. Endothelial cell injury in cardi- ovascular surgery. Ann Thorac Surg 1996;62:915922.
  • Piriou V, Claudel JP, Bastien O, Ross S, Lehot JJ. Se- vere systemic cholesterol embolisation after open heart surgery. Br J Anaesth 1996;77:277–280.
  • Hilberman M, Derby GC, Spencer RJ, Stinson EB. Se- quential pathophysiological changes characterizing the progression from renal dysfunction to acute renal failure following cardiac operation. J Thorac Cardiovasc Surg 1980;97:838844.
  • Lin CL, Pan KY, Hsu PY, Yang HY, Guo HL, Huang CC. Preoperative 24hour urine amount as an indepen- dent predictor of renal outcome in poor cardiac function patients after coronary artery bypass grafting. J Crit Ca- re 2004;19:9298.
  • Marik PE, Sibbald WJ., Effect of storedblood transfu- sion on oxygen delivery in patients with sepsis. JAMA 1993;269:30249
  • Loef BG, Epema AH, Smilde TB, Henning RH, Ebels T, Navis G, Stegeman CA. Immediate postoperative renal function deterioration in cardiac surgical patients pre- dicts inhospital mortality and longterm survival. J Am Soc Nephrol 2005;16:195200.
  • Brown JR, Cochran RP, Dacey LJ, Ross CS, Kunzel- man KS, Dunton RF, Braxton JH, Charlesworth DC, Clo- ugh RA, Helm RE, Leavitt BJ, Mackenzie TA, O’Connor GT. Perioperative increases in serum creatinine are pre- dictive of increased 90day mortality after coronary artery bypass graft surgery. Circulation 2006;114:I40913.
There are 39 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Mustafa Saçar This is me

Gökhan Önem This is me

Yal›n Tolga Yaylal› This is me

İbrahim Susam This is me

Fahri Adal› This is me

Ahmet Baltalarl› This is me

Publication Date January 1, 2008
Published in Issue Year 2009 Volume: 12 Issue: 1

Cite

APA Saçar, M. ., Önem, G. ., Yaylal›, Y. T. ., Susam, İ. ., et al. (2008). Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri. Koşuyolu Kalp Dergisi, 12(1), 10-17.
AMA Saçar M, Önem G, Yaylal› YT, Susam İ, Adal› F, Baltalarl› A. Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri. Koşuyolu Kalp Dergisi. January 2008;12(1):10-17.
Chicago Saçar, Mustafa, Gökhan Önem, Yal›n Tolga Yaylal›, İbrahim Susam, Fahri Adal›, and Ahmet Baltalarl›. “Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri”. Koşuyolu Kalp Dergisi 12, no. 1 (January 2008): 10-17.
EndNote Saçar M, Önem G, Yaylal› YT, Susam İ, Adal› F, Baltalarl› A (January 1, 2008) Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri. Koşuyolu Kalp Dergisi 12 1 10–17.
IEEE M. . Saçar, G. . Önem, Y. T. . Yaylal›, İ. . Susam, F. . Adal›, and A. . Baltalarl›, “Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri”, Koşuyolu Kalp Dergisi, vol. 12, no. 1, pp. 10–17, 2008.
ISNAD Saçar, Mustafa et al. “Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri”. Koşuyolu Kalp Dergisi 12/1 (January 2008), 10-17.
JAMA Saçar M, Önem G, Yaylal› YT, Susam İ, Adal› F, Baltalarl› A. Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri. Koşuyolu Kalp Dergisi. 2008;12:10–17.
MLA Saçar, Mustafa et al. “Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri”. Koşuyolu Kalp Dergisi, vol. 12, no. 1, 2008, pp. 10-17.
Vancouver Saçar M, Önem G, Yaylal› YT, Susam İ, Adal› F, Baltalarl› A. Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri. Koşuyolu Kalp Dergisi. 2008;12(1):10-7.