Thongprayoon Charat, Cheungpasitporn Wisit, Lin Jing, Mao Michael A, Qian Qi
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA.
Clin Kidney J. 2017 Oct;10(5):648-654. doi: 10.1093/ckj/sfx016. Epub 2017 Apr 16.
Data on postoperative acute kidney injury (AKI) in octogenarians are limited. This study examines the AKI occurrence and clinical impact in octogenarians following open-heart valve replacement surgery in two periods over the last 15 years.
A total of 452 consecutive octogenarians (non-kidney transplant and non-dialysis) who underwent heart valve replacement at the Mayo Clinic during the years 2011-13 (contemporary cohort) were examined. The results were compared with a comparable 209 consecutive octogenarians in 2002-03 (past cohort). Pre-existing chronic kidney disease (CKD) was defined based on estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula). Outcomes included postoperative AKI defined by the Acute Kidney Injury Network (AKIN) criteria, length of hospital stay (LOS), discharge disposition and patient survival (hospital and 1 year).
AKI occurrence in the contemporary cohort was lower than the past cohort (35% versus 47%, respectively, P < 0.003). Compared with the past cohort, the contemporary cohort had fewer known perioperative AKI risk factors (pre-existing CKD, comorbidity, heart failure, surgical duration, cross-clamp time, blood transfusion and large-volume intravenous fluids). In both periods, AKI adversely impacts mortality, LOS and discharge to a care facility.
Postoperative AKI in octogenarians following heart valve replacement surgery has declined over the last decade. As a result, the AKI-attributable percentage mortality has accordingly decreased. However, AKI continues to exert a heavy morbidity and mortality burden. These results are highly pertinent to practice since the octogenarian population is growing.
关于八旬老人术后急性肾损伤（AKI）的数据有限。本研究调查了过去15年中两个时期八旬老人在心脏瓣膜置换手术后的AKI发生率及临床影响。
对2011 - 2013年期间在梅奥诊所接受心脏瓣膜置换手术的452例连续八旬老人（非肾移植且非透析患者）进行了检查（当代队列）。将结果与2002 - 2003年期间209例连续八旬老人（过去队列）进行比较。根据估算的肾小球滤过率（慢性肾脏病流行病学合作公式）定义既往存在的慢性肾脏病（CKD）。结局指标包括根据急性肾损伤网络（AKIN）标准定义的术后AKI、住院时间（LOS）、出院去向及患者生存率（住院期间和1年）。
当代队列中AKI的发生率低于过去队列（分别为35%和47%，P < 0.003）。与过去队列相比，当代队列中已知的围手术期AKI危险因素较少（既往存在的CKD、合并症、心力衰竭、手术时间、主动脉阻断时间、输血及大量静脉输液）。在两个时期，AKI均对死亡率、LOS及转至护理机构产生不利影响。
在过去十年中，八旬老人心脏瓣膜置换手术后的术后AKI有所下降。因此，AKI所致的死亡率百分比相应降低。然而，AKI仍然造成沉重的发病和死亡负担。鉴于八旬老人群体在不断增加，这些结果与临床实践高度相关。
