Welten Gijs M J M, Chonchol Michel, Schouten Olaf, Hoeks Sanne, Bax Jeroen J, van Domburg Ron T, van Sambeek Marc, Poldermans Don
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Nephrol Dial Transplant. 2008 Dec;23(12):3867-73. doi: 10.1093/ndt/gfn381. Epub 2008 Jul 15.
Acute kidney injury (AKI) after major vascular surgery is an important risk factor for adverse long-term outcomes. The pleiotropic effects of statins may reduce kidney injury caused by perioperative episodes of hypotension and/or suprarenal clamping and improve long-term outcomes.
Of 2170 consecutive patients undergoing lower extremity bypass or abdominal aortic surgery from 1995 to 2006, cardiac risk factors and medication were noted. A total of 515/1944 (27%) patients were statin users. Creatinine clearance (CrCl) was assessed preoperatively at 1, 2 and 3 days after surgery. Outcome measures were postoperative AKI and long-term mortality. Postoperative kidney injury was defined as a >10% decrease in CrCl on Day 1 or 2, compared to the baseline. Recovery of kidney function was defined as a CrCl >90% of the baseline value at Day 3 after surgery. Multivariable Cox regression analysis, including baseline cardiovascular risk factors, baseline CrCl and propensity score for statin use, was applied to evaluate the influence of statins on early postoperative kidney injury and long-term survival.
AKI occurred in 664 (34%) patients [median -25% CrCl, range (-10% to -71%)]. Of these 664 patients, 313 (47%) had a complete recovery of kidney function at Day 3 after surgery. Age, hypertension, suprarenal cross-clamping and baseline CrCl predicted the development of kidney injury during the postoperative period. The incidence of kidney injury was similar among statin users and non-users (29% versus 25%, OR 1.15, 95% CI 0.9-1.5). However, if kidney function deteriorated, statin use was associated with increased odds of complete kidney function recovery (OR 2.0, 95% CI 1.0-3.8). During a mean follow-up of 6.24 years, half of the patients died (55%). Importantly, statin use was also associated with an improved long-term survival, irrespective of kidney function change (HR 0.60, 95% CI 0.48-0.75).
Statin use is associated with improved recovery from AKI after major surgery and has a beneficial effect on long-term survival.
大血管手术后的急性肾损伤（AKI）是不良长期预后的重要危险因素。他汀类药物的多效性作用可能减轻围手术期低血压和/或肾上腹主动脉阻断引起的肾损伤，并改善长期预后。
在1995年至2006年间连续接受下肢搭桥手术或腹主动脉手术的2170例患者中，记录其心脏危险因素和用药情况。共有515/1944例（27%）患者使用他汀类药物。术前、术后第1、2和3天评估肌酐清除率（CrCl）。观察指标为术后AKI和长期死亡率。术后肾损伤定义为术后第1天或第2天CrCl较基线值下降>10%。肾功能恢复定义为术后第3天CrCl>基线值的90%。采用多变量Cox回归分析，包括基线心血管危险因素、基线CrCl和他汀类药物使用的倾向评分，以评估他汀类药物对术后早期肾损伤和长期生存的影响。
664例（34%）患者发生AKI[CrCl中位数下降25%，范围（-10%至-71%）]。在这664例患者中，313例（47%）在术后第3天肾功能完全恢复。年龄、高血压、肾上腹主动脉阻断和基线CrCl可预测术后肾损伤的发生。他汀类药物使用者和非使用者的肾损伤发生率相似（29%对25%，OR 1.15，95%CI 0.9-1.5）。然而，如果肾功能恶化，使用他汀类药物与肾功能完全恢复的几率增加相关（OR 2.0，95%CI 1.0-3.8）。在平均6.24年的随访期间，一半的患者死亡（55%）。重要的是，无论肾功能变化如何，使用他汀类药物也与改善长期生存相关（HR 0.60，95%CI 0.48-0.75）。
使用他汀类药物与大手术后AKI的恢复改善相关，并对长期生存有有益影响。
