术前隐匿性肾功能不全增加了心脏手术后发生进行性慢性肾脏病的年龄依赖性风险。
Preoperative hidden renal dysfunction add an age dependent risk of progressive chronic kidney disease after cardiac surgery.
作者信息
Xu Jiarui, Yu Jiawei, Xu Xialian, Shen Bo, Wang Yimei, Jiang Wuhua, Lv Wenlv, Fang Yi, Luo Zhe, Wang Chunsheng, Teng Jie, Ding Xiaoqiang
机构信息
Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.
出版信息
J Cardiothorac Surg. 2019 Aug 22;14(1):151. doi: 10.1186/s13019-019-0977-9.
BACKGROUND
To study different value of estimated glomerular filtration rate with normal serum creatinine whether is a risk factor for hidden renal function of cardiac surgery outcomes.
METHODS
A total of 1744 cardiac surgery patients with serum creatinine ≤1.2 mg/dL (female)/1.5 mg/dL (male) were divided into 3 groups: estimated glomerular filtration rate ≥ 90 mL/min/1.73 m (no renal dysfunction, n = 829), 60 ≤ estimated glomerular filtration rate < 90 mL/min/1.73 m (hidden renal dysfunction, n = 857), estimated glomerular filtration rate < 60 mL/min/1.73 m (known renal dysfunction, n = 58) and followed up for 3 years. Multivariate regression analyses for risk factors of postoperative acute kidney injury.
RESULTS
The proportion of preoperative hidden renal dysfunction was 67.1% among patients ≥ 65 years old and 44.1% among patients < 65 years old. Multivariate Cox regression analyses showed that for patients < 65 years, known renal dysfunction was a risk factor for postoperative acute kidney injury (P < 0.01) and progressive chronic kidney disease (P = 0.018), while hidden renal dysfunction was a risk factor for progressive chronic kidney disease (P = 0.024). For patients ≥ 65 years, only known renal dysfunction was a risk factors for 3-year mortality (P = 0.022) and progressive chronic kidney disease (P < 0.01).
CONCLUSION
Hidden renal dysfunction was common in patients with normal serum creatinine for cardiac surgery, with a prevalence of 49.1%. For patients < 65 years old, hidden renal dysfunction was an independent risk factor for progressive chronic kidney disease.
背景
研究血清肌酐正常时估算肾小球滤过率的不同数值是否为心脏手术预后潜在肾功能的危险因素。
方法
将1744例血清肌酐≤1.2mg/dL（女性）/1.5mg/dL（男性）的心脏手术患者分为3组：估算肾小球滤过率≥90mL/min/1.73m²（无肾功能障碍，n = 829），60≤估算肾小球滤过率<90mL/min/1.73m²（潜在肾功能障碍，n = 857），估算肾小球滤过率<60mL/min/1.73m²（已知肾功能障碍，n = 58），并随访3年。对术后急性肾损伤的危险因素进行多因素回归分析。
结果
≥65岁患者术前潜在肾功能障碍的比例为67.1%，<65岁患者为44.1%。多因素Cox回归分析显示，对于<65岁的患者，已知肾功能障碍是术后急性肾损伤（P<0.01）和进行性慢性肾病（P = 0.018）的危险因素，而潜在肾功能障碍是进行性慢性肾病的危险因素（P = 0.024）。对于≥65岁的患者，只有已知肾功能障碍是3年死亡率（P = 0.022）和进行性慢性肾病（P<0.01）的危险因素。
结论
心脏手术患者血清肌酐正常时，潜在肾功能障碍很常见，患病率为49.1%。对于<65岁的患者，潜在肾功能障碍是进行性慢性肾病的独立危险因素。
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