DOI: https://doi.org/10.14710/jai.v0i0.76588

Management of Continuous Renal Replacement Therapy Following Coronary Artery Bypass Grafting in the Intensive Care Unit

Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/RSUP Dr. Sardjito, Yogyakarta, Indonesia, Indonesia

Received: 30 Jul 2025; Revised: 27 Oct 2025; Accepted: 11 Dec 2025; Available online: 15 Dec 2025.
Open Access Copyright 2026 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Abstract

Background: Acute kidney injury (AKI) after cardiac surgery is a serious complication with a high occurrence, leading to increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is the preferred method for replacing kidney function in patients with hemodynamic instability, especially during the critical postoperative period in the intensive care unit (ICU).

Case: A 76-year-old man with a history of ischemic heart disease and chronic heart failure underwent off-pump coronary artery bypass grafting (CABG). The patient had comorbidities including obesity, obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD), pneumonia, and chronic kidney disease (CKD). During intensive postoperative care, the patient experienced a progressive decrease in urine output, rising urea and creatinine levels, and significant fluid overload. CRRT with continuous venovenous hemodiafiltration (CVVHDF) mode was started on the first day of ICU admission, and clinical improvement was observed after four days of therapy.

Discussion: Patients with multiple comorbidities often experience a deterioration in kidney function after surgery, requiring prompt intervention. The critical role of CRRT in stabilizing fluid and metabolic balance, while simultaneously maintaining hemodynamic stability, cannot be overstated. Careful monitoring of volume status, hemodynamics, and laboratory results is essential to determine the duration of therapy and evaluate its effectiveness.

Conclusion: CRRT is an effective treatment for patients after CABG with AKI and hemodynamic instability. A team-based approach and proper monitoring are crucial for the success of therapy and patient recovery.

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Management of Continuous Renal Replacement Therapy Following Coronary Artery Bypass Grafting in Intensive Care Unit
Subject Continuous Renal Replacement Therapy, Acute Kidney Injury, Coronary Artery Bypass Grafting, Intensive Care Unit, Hemodynamics
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Keywords: acute kidney injury; continuous renal replacement therapy; coronary artery bypass grafting; hemodynamics; intensive care unit
Funding: Universitas Gadjah Mada

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Section: Case Reports
Language : EN
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