Nephrology and Dialysis, "St. Bassiano" Hospital, Bassano del Grappa, Italy.
Internal Medicine, School of Nephrology, University of Catania, Catania, Italy.
J Nephrol. 2018 Aug;31(4):561-569. doi: 10.1007/s40620-018-0467-5. Epub 2018 Jan 17.
Patients undergoing abdominal aortic aneurysm (AAA) surgery with suprarenal clamping are at high risk for acute kidney injury (AKI) and major cardiac and cerebrovascular events (MACCE). We aimed to assess whether the stroke volume variation (SVV), a measure of hemodynamic instability, is associated with AKI in hypertensive patients undergoing elective AAA surgery with suprarenal clamping.
In a cohort of 51 hypertensive patients, we performed serial measurements of SVV (n = 459) and serum creatinine (sCr) (n = 255). AKI was defined according to the KDIGO clinical practice guidelines. Data were analyzed by repeated-measures ANOVA and regression analysis of time-integrated changes of both SVV and sCr.
AKI developed in 45% of patients (stage 1: 31%; stage 2: 10%; stage 3: 2%). The diuresis during surgery (beta - 0.29 Z-score 95% [CI - 0.54, - 0.05]; p = 0.02), clamp time (beta 0.29 Z-score [0.05-0.52]; p = 0.02), and time-integrated changes in SVV from baseline to 12 h after surgery (beta 0.31 Z-score [0.03-0.60]; p = 0.03) were independent predictors of the time-integrated changes in sCr from baseline to 48 h after the end of surgery. In a model adjusted for age and sex, patients with AKI had an increased risk for MACCE during a mean follow-up of 3.5 ± 1.1 years (HR 5.53 [1.52-20.06]; p = 0.004).
SVV increases progressively during and after AAA surgery in subjects who will develop AKI. The increase of SVV precedes and predicts the rise in sCr and is a good discriminator of the development of AKI. AKI is associated with an increased long-term risk for MACCE.
接受腹主动脉瘤 (AAA) 手术并夹闭肾上极的患者发生急性肾损伤 (AKI) 和主要心脏和脑血管事件 (MACCE) 的风险较高。我们旨在评估在接受肾上极夹闭的择期 AAA 手术的高血压患者中，血流动力学不稳定的测量指标 - 每搏量变异度 (SVV) 是否与 AKI 相关。
在 51 例高血压患者的队列中，我们进行了 SVV（n=459）和血清肌酐 (sCr)（n=255）的系列测量。根据 KDIGO 临床实践指南定义 AKI。通过重复测量 ANOVA 和 SVV 和 sCr 时间积分变化的回归分析来分析数据。
45%的患者发生 AKI（第 1 期：31%；第 2 期：10%；第 3 期：2%）。手术期间的尿量（β -0.29 Z 评分 95%[CI-0.54，-0.05]；p=0.02）、夹闭时间（β 0.29 Z 评分[0.05-0.52]；p=0.02）以及从基线到手术后 12 小时 SVV 的时间积分变化（β 0.31 Z 评分[0.03-0.60]；p=0.03）是手术后 48 小时内 sCr 时间积分变化的独立预测因子。在调整年龄和性别后的模型中，AKI 患者在平均 3.5±1.1 年的随访期间发生 MACCE 的风险增加（HR 5.53[1.52-20.06]；p=0.004）。
在将发生 AKI 的患者中，SVV 在 AAA 手术期间和之后逐渐增加。SVV 的增加先于并预测 sCr 的升高，是 AKI 发生的良好鉴别指标。AKI 与 MACCE 的长期风险增加相关。
