Service de Chirurgie Cardio-Vasculaire, Centre Hospitalier Universitaire Le Bocage CHU Le Bocage, Dijon, France.
J Vasc Surg. 2010 Jan;51(1):43-50. doi: 10.1016/j.jvs.2009.08.070.
Renal insufficiency (RI) seems to be a source of complications after carotid endarterectomy (CEA). However, published studies do not use a common definition of RI. Our objective was to analyze the effects of RI on carotid surgery using three classifications of renal function.
Using a prospective database, we studied renal function and postoperative complications in patients operated on between January 1, 2003 and December 31, 2008. Renal function was studied using the level of plasma creatinine, creatinine clearance calculated according to the Cockcroft formula, and to the Modification of Diet in Renal Disease (MDRD) equation. For each method, the patients were divided into three groups: normal renal function, moderate RI, and severe RI. The principal judgment criterion was the 30-day non-fatal stroke and death rate.
The analysis concerned 961 CEAs carried out in 901 patients. The 30-day non-fatal stroke and death rate was 2%. In the analysis of renal function using the level of creatinine, there was no statistical difference between the groups in the 30-day stroke and death rate (normal renal function: 1.8%, moderate: 2.7%, severe: 8.3%, P = .21). The analysis of renal function according to creatinine clearance calculated using the Cockcroft formula showed that in the severe RI group, the stroke and death rate was higher than in the other two groups (normal renal function: 1.7%, moderate RI: 1.4%, severe RI: 7.5%, P = .004). Analysis using the MDRD formula showed similar differences between the severe RI group and the other two with a higher rate of 30-day stroke and death (normal renal function: 1.4%, moderate RI: 1.7%, severe RI: 12.5%, P < .001). Subgroup analysis showed that among patients with severe RI according to the creatinine clearance, those with symptomatic carotid stenosis had the highest incidences of non-fatal stroke and death (Cockcroft, n = 19: 21.1%, MDRD, n = 10: 40%).
Severe RI is a risk factor for complications after carotid surgery. Creatinine clearance calculated according to the MDRD formula correlates most closely with these complications. Symptomatic patients with severe RI, according to the creatinine clearance, are at high risk with a very high level of postoperative complications.
肾功能不全（RI）似乎是颈动脉内膜切除术（CEA）后发生并发症的一个原因。然而，已发表的研究并未使用肾功能不全的通用定义。我们的目的是使用三种肾功能分类方法分析 RI 对颈动脉手术的影响。
我们使用前瞻性数据库研究了 2003 年 1 月 1 日至 2008 年 12 月 31 日期间接受手术的患者的肾功能和术后并发症。使用血浆肌酐水平、根据 Cockcroft 公式和改良肾脏病饮食（MDRD）方程计算的肌酐清除率来研究肾功能。对于每种方法，患者被分为三组：正常肾功能、中度 RI 和重度 RI。主要判断标准是 30 天内非致命性中风和死亡率。
该分析涉及 901 例患者中的 961 例 CEA。30 天内非致命性中风和死亡率为 2%。在使用肌酐水平分析肾功能时，30 天内中风和死亡率在各组之间无统计学差异（正常肾功能：1.8%，中度：2.7%，重度：8.3%，P =.21）。根据 Cockcroft 公式计算的肌酐清除率分析肾功能显示，在重度 RI 组中，中风和死亡率高于其他两组（正常肾功能：1.7%，中度 RI：1.4%，重度 RI：7.5%，P =.004）。使用 MDRD 公式分析显示重度 RI 组与其他两组之间存在类似差异，30 天内中风和死亡率较高（正常肾功能：1.4%，中度 RI：1.7%，重度 RI：12.5%，P <.001）。亚组分析显示，在根据肌酐清除率确定的重度 RI 患者中，有症状颈动脉狭窄患者的非致命性中风和死亡发生率最高（Cockcroft，n = 19：21.1%，MDRD，n = 10：40%）。
重度 RI 是颈动脉手术后并发症的危险因素。根据 MDRD 公式计算的肌酐清除率与这些并发症相关性最强。根据肌酐清除率确定的有症状重度 RI 患者风险很高，术后并发症发生率非常高。
