Barisione Chiara, Garibaldi Silvano, Brunelli Claudio, Balbi Manrico, Spallarossa Paolo, Canepa Marco, Ameri Pietro, Viazzi Francesca, Verzola Daniela, Lorenzoni Alessandra, Baldassini Riccardo, Palombo Domenico, Pane Bianca, Spinella Giovanni, Ghigliotti Giorgio
Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy.
Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy.
Intern Emerg Med. 2016 Mar;11(2):205-12. doi: 10.1007/s11739-015-1328-z. Epub 2015 Oct 28.
Chronic kidney disease (CKD), cardiac damage (CD) and the combination of the two are associated with increased morbidity and death in patients admitted to vascular surgery units. We assessed the prevalence of cardiac and renal damage and cardiorenal syndrome (CRS) in 563 patients with abdominal aortic aneurysms (AAA) who underwent cardiac screening before either an endovascular procedure (EVAR) or open surgery (OS) for aneurysm repair. CD was defined by ≥stage B as per the ACC/AHA classification of congestive heart failure (CHF), while CKD was defined by estimated GFR <60 mL/min/1.73 m(2) (CKD-EPI). Anemia [World Health Organization (WHO) guidelines] and iron deficiency (ID) (criteria for CHF patients) were also calculated. AAA patients were stratified into the following groups: CD, CKD, CRS or none of these conditions [no risk factors (NoRF)]. The prevalence of isolated cardiac and renal structural damage, of combined cardiorenal damage and of ID was 24.1, 15.0, 20.6 and 23.4 %, respectively. The frequency of anemia (mostly unrecognized) among the groups increased from NoRF (12.8 %)/CKD (19 %)/CD (25 %) up to CRS (38.8 %). This large-scale observational study provides clues for the increased CD/CKD risk profiles of unselected AAA patients, and underlines the need for better identification of ID/anemia and for appropriate treatment of CKD and CD before these patients undergo EVAR/OS.
慢性肾脏病（CKD）、心脏损害（CD）以及两者并存与血管外科病房收治患者的发病率和死亡率增加相关。我们评估了563例腹主动脉瘤（AAA）患者在接受血管内修复术（EVAR）或开放手术（OS）修复动脉瘤之前进行心脏筛查时心脏和肾脏损害以及心肾综合征（CRS）的患病率。根据美国心脏病学会/美国心脏协会（ACC/AHA）充血性心力衰竭（CHF）分类，CD定义为≥B期，而CKD定义为估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²（CKD-EPI）。还计算了贫血[世界卫生组织（WHO）指南]和缺铁（ID）（CHF患者标准）情况。AAA患者被分为以下几组：CD、CKD、CRS或无这些情况[无危险因素（NoRF）]。孤立性心脏和肾脏结构损害、合并心肾损害以及ID的患病率分别为24.1%、15.0%、20.6%和23.4%。各组中贫血（大多未被识别）的发生率从NoRF组（12.8%）/CKD组（19%）/CD组（25%）增加到CRS组（38.8%）。这项大规模观察性研究为未选择的AAA患者中CD/CKD风险增加的情况提供了线索，并强调在这些患者接受EVAR/OS之前，需要更好地识别ID/贫血以及对CKD和CD进行适当治疗。
