Heringlake M, Knappe M, Vargas Hein O, Lufft H, Kindgen-Milles D, Böttiger B W, Weigand M R, Klaus S, Schirmer U
Department of Anaesthesiology, University of Lübeck, Lübeck, Germany.
Minerva Anestesiol. 2006 Jul-Aug;72(7-8):645-54.
The aim of this study was to determine the incidence of renal dysfunction according to the Acute-Dialysis-Quality Initiative-(ADQI)-RIFLE grading system in cardiac surgery in Germany in 2003 and to determine if variations in the incidence of renal dysfunction are related to clinical practice patterns.
prospective cohort analysis and practice pattern survey.
81 hospitals were requested to report prospectively sampled quality-management-data on patient load, case mix, aortic-cross-clamp-time, baseline and maximal plasma creatinine (CreaP), new-onset-renal-replacement-therapy, and clinical practice concerning the use of fluids, inotropic and vasopressor drugs, and diuretics. Fifty-one (63%) centers answered the survey. Twenty-six centers (32%)(representative for 29 623 patients(reported creatinine data.
The incidence of a 50%, 100%, or 150% increase in plasma creatinine (graded as risk, injury, and failure according to the ADQI-RIFLE-system) were 9% (2-40%), 5% (0.8-30%), and 2% (0.6-33%), respectively, overall 15.4% (3.1-75%). The incidence of new-onset renal-replacement-therapy was 4.5% (0.6-24%). Centers with a low incidence of renal dysfunction 8.7% (3.1-15.4%)differed from those with a high incidence 51% (15.7-75%)by being more liberal with fluids, not preferring dopamine in ''renal'' or inotropic doses, and preferring noradrenaline as a vasopressor (all: P<0.05), but not by case mix, frequency of urgent or emergency cases, and the use of loop diuretics.
Renal dysfunction is a frequent complication following cardiac surgery in many German heart centers. The variance between centers may not be explained by patient heterogeneity and may be related to different strategies regarding fluid therapy and the use of inotropes and vasopressors.
本研究旨在根据急性透析质量倡议（ADQI）-RIFLE分级系统确定2003年德国心脏手术中肾功能不全的发生率，并确定肾功能不全发生率的差异是否与临床实践模式相关。
前瞻性队列分析和实践模式调查。
要求81家医院前瞻性报告有关患者数量、病例组合、主动脉阻断时间、基线和最大血浆肌酐（CreaP）、新发肾脏替代治疗以及液体、强心剂和血管加压药及利尿剂使用的质量管理数据。51家（63%）中心回复了调查。26家中心（32%）（代表29623例患者）报告了肌酐数据。
血浆肌酐升高50%、100%或150%（根据ADQI-RIFLE系统分级为风险、损伤和衰竭）的发生率分别为9%（2-40%）、5%（0.8-30%）和2%（0.6-33%），总体为15.4%（3.1-75%）。新发肾脏替代治疗的发生率为4.5%（0.6-24%）。肾功能不全发生率低（8.7%，3.1-15.4%）的中心与发生率高（51%，15.7-75%）的中心的差异在于，前者在液体使用上更宽松，在“肾脏”或强心剂量时不倾向于使用多巴胺，而倾向于使用去甲肾上腺素作为血管加压药（所有：P<0.05），但在病例组合、紧急或急诊病例频率以及襻利尿剂的使用方面没有差异。
在许多德国心脏中心，肾功能不全是心脏手术后常见的并发症。中心之间的差异可能无法用患者异质性来解释，可能与液体治疗以及强心剂和血管加压药的使用策略不同有关。
