Ried Michael, Haneya Assad, Kolat Philipp, Potzger Tobias, Puehler Thomas, Schmid Cristof, Diez Claudius
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
Thorac Cardiovasc Surg. 2012 Feb;60(1):51-6. doi: 10.1055/s-0031-1295567. Epub 2011 Dec 29.
We tested the hypothesis that octogenarians develop more frequently renal dysfunction compared with septuagenarians after cardiac surgery.
A retrospective, observational study on an age-, gender- and operation-matched cohort of 598 patients, (299 octogenarians vs. 299 septuagenarians) who underwent cardiac surgery between January 2006 and August 2009, was performed. Kidney function was estimated with the abbreviated Modification in Renal Disease equation and acute kidney injury was defined as a decrease of glomerular filtration rate ≥50%.
Operations included 246 coronary, 198 isolated valve, and 154 combined coronary and valve procedures. Mean logistic EuroSCORE was 8.5% in septuagenarians and 13.2% in octogenarians. Octogenarians had significantly more frequent and estimated GFR < 60 mL/min/1.73 m² (44 vs. 34.4%, p = 0.02). The incidence of dialysis-dependent acute kidney failure did not differ between both groups (6.7 vs. 5.4%, p = 0.60). Postoperative decline of glomerular filtration rate <25% occurred significantly more often in septuagenarians (40 vs. 30%, p = 0.02). Septuagenarians with a preoperative GFR < 60 mL/min/1.73 m² had a higher 30-day mortality compared with patients with a GFR > 60 mL/min/1.73 m² (10.9 vs. 3.1%, p = 0.02). Overall, 30-day mortality in octogenarians was 7.7% without significant differences with respect to preoperative GFR.
Octogenarians do not develop acute kidney failure more frequently than their matched septuagenarian counterparts. They can be operated on at an acceptable risk for morbidity and mortality. Preoperative impaired renal function is associated with higher risk for mortality in septuagenarians.
我们检验了这样一个假设，即与七十多岁的患者相比，八十多岁的患者在心脏手术后发生肾功能不全的频率更高。
对2006年1月至2009年8月期间接受心脏手术的598例患者（299例八十多岁患者与299例七十多岁患者）进行了一项年龄、性别和手术匹配队列的回顾性观察研究。采用简化的肾脏疾病改良方程评估肾功能，急性肾损伤定义为肾小球滤过率下降≥50%。
手术包括246例冠状动脉手术、198例单纯瓣膜手术和154例冠状动脉与瓣膜联合手术。七十多岁患者的平均逻辑欧洲心脏手术风险评估系统（EuroSCORE）为8.5%，八十多岁患者为13.2%。八十多岁患者的估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²更为常见（44%对34.4%，p = 0.02）。两组间依赖透析的急性肾衰竭发生率无差异（6.7%对5.4%，p = 0.60）。七十多岁患者术后肾小球滤过率下降<25%的情况明显更常见（40%对30%，p = 0.02）。术前eGFR<60 mL/min/1.73 m²的七十多岁患者30天死亡率高于eGFR>60 mL/min/1.73 m²的患者（10.9%对3.1%，p = 0.02）。总体而言，八十多岁患者的30天死亡率为7.7%，术前eGFR方面无显著差异。
八十多岁患者发生急性肾衰竭的频率并不比年龄匹配的七十多岁患者更高。他们可以在可接受的发病和死亡风险下接受手术。术前肾功能受损与七十多岁患者的死亡风险较高相关。
