心脏导管插入术时机和造影剂剂量对心脏手术后急性肾损伤的影响。
Impact of cardiac catheterization timing and contrast media dose on acute kidney injury after cardiac surgery.
作者信息
Jiang Wuhua, Yu Jiawei, Xu Jiarui, Shen Bo, Wang Yimei, Luo Zhe, Wang Chunsheng, Ding Xiaoqiang, Teng Jie
机构信息
Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Rd, Shanghai, 200032, China.
Shanghai Institute of Kidney and Dialysis, Shanghai, China.
出版信息
BMC Cardiovasc Disord. 2018 Oct 5;18(1):191. doi: 10.1186/s12872-018-0928-8.
BACKGROUND
The association between pre-operative cardiac catheterization and cardiac surgery associated acute kidney injury (CSA-AKI) has been reported inconsistently. The purpose of this study is to evaluate the effect of the catheterization timing and contrast media dose on the incidence of postoperative acute kidney injury.
METHODS
Patients who underwent cardiac catheterization and cardiac surgery successively from January 2015 to December 2015 were prospectively enrolled in this study. The primary outcome was CSA-AKI which was defined as the Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO) criteria. Univariate analysis and multivariate regression were performed to identify the predictors for CSA-AKI. Baseline characteristics were balanced with propensity score method for better adjustment.
RESULTS
A total of 1069 consecutive eligible patients were enrolled into this study. The incidence of CSA-AKI and AKI requiring renal replacement therapy (AKI-RRT) were 38.5% (412/1069) and 1.9% (20/1069) respectively. Preoperative estimated glomerular filtration rate less than 60 mL/min/1.73m (OR = 2.843 95% CI 1.374-5.882), the time interval between catheterization and surgery≤7 days (OR = 2.546, 95% CI 1.548-4.189) and the dose of contrast media (CM) > 240 mg/kg (OR = 2.490, 95%CI 1.392-4.457) were identified as predictors for CSA-AKI. In the patients with the dose of CM > 240 mg/kg, the incidence of CSA-AKI was higher in patients who underwent cardiac catheterization ≤7 days before cardiac surgery than in those of > 7 days before cardiac surgery (39.4% vs. 28.8%, p = 0.025). The longer interval of more than 7 days was revealed to be inversely associated with CSA-AKI through logistic regression (OR = 0.579, 95% CI 0.337-0.994).
CONCLUSION
Catheterization within 7 days of cardiac surgery and a dose of CM > 240 mg/kg were associated with the onset of CSA-AKI. For patients who received a dose of CM > 240 mg/kg, postponing the cardiac surgery is potentially beneficial to reduce the risk of CSA-AKI.
背景
术前心脏导管插入术与心脏手术相关急性肾损伤（CSA-AKI）之间的关联报道并不一致。本研究的目的是评估导管插入时间和造影剂剂量对术后急性肾损伤发生率的影响。
方法
前瞻性纳入2015年1月至2015年12月先后接受心脏导管插入术和心脏手术的患者。主要结局是CSA-AKI，其定义采用肾脏病：改善全球预后定义和分期（KDIGO）标准。进行单因素分析和多因素回归以确定CSA-AKI的预测因素。采用倾向评分法平衡基线特征以进行更好的调整。
结果
本研究共纳入1069例连续符合条件的患者。CSA-AKI和需要肾脏替代治疗的急性肾损伤（AKI-RRT）的发生率分别为38.5%（412/1069）和1.9%（20/1069）。术前估计肾小球滤过率低于60 mL/min/1.73m²（OR = 2.843，95%CI 1.374 - 5.882）、导管插入术与手术之间的时间间隔≤7天（OR = 2.546，95%CI 1.548 - 4.189）以及造影剂（CM）剂量>240 mg/kg（OR = 2.490，95%CI 1.392 - 4.457）被确定为CSA-AKI的预测因素。在CM剂量>240 mg/kg的患者中，心脏手术前≤7天接受心脏导管插入术的患者CSA-AKI发生率高于心脏手术前>7天接受心脏导管插入术的患者（39.4%对28.8%，p = 0.025）。通过逻辑回归显示，超过7天的较长时间间隔与CSA-AKI呈负相关（OR = 0.579，95%CI 0.337 - 0.994）。
结论
心脏手术7天内进行导管插入术以及CM剂量>240 mg/kg与CSA-AKI的发生有关。对于接受CM剂量>240 mg/kg的患者，推迟心脏手术可能有利于降低CSA-AKI的风险。
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