NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, ChuHsien-I Memorial Hospital and Tianjin Institute of Endocrinology' Tianjin Medical University, No. 6 Huanrui North Road, Ruijing Street, Beichen District, Tianjin, China.
Department of endocrinology, TEDA International Cardiovascular Disease Hospital, No. 61 Third Avenue, Tianjin Economic and Technological Development Zone, Tianjin, China.
Gen Thorac Cardiovasc Surg. 2021 Oct;69(10):1392-1399. doi: 10.1007/s11748-021-01599-0. Epub 2021 Feb 6.
Furosemide is usually administered before the Coronary artery bypass grafting (CABG) to improve water-sodium retention. However, no final conclusions are available on the postoperative renal outcome of furosemide. We evaluated the effect of preoperative furosemide on acute kidney injury (AKI) after CABG.
We recorded the use of furosemide 14 days before surgery in all patients who underwent CABG from 2016 to 2017. Patients were divided into furosemide (F) group and non-furosemide (NF) group according to preoperative use of furosemide. A 1:1 propensity score matching was performed. Multivariate analyses were conducted to determine risk factors for AKI after CABG.
Overall, 974 patients were included in the study, of which 82 cases were complicated with postoperative AKI. The incidence of AKI was significantly increased in F group than NF group (28.9% vs. 7.4%, p = 0.000). After adjusting for risk factors, the incidence of AKI in the F group was 5.34 times more than the NF group (95% confidence interval [CI] 2.45-11.64; p = 0.000). The incidence of AKI increased significantly when the cumulative dosage of furosemide exceeded 110 mg (odds ratio [OR] 6.23; 95% CI 2.07-18.74, p = 0.001) and 250 mg (OR 8.31; 95% CI 2.87-24.02, p = 0.000). After the propensity-matching group analysis, same results were obtained.
The incidence of AKI after CABG was related to the use of preoperative furosemide, and it increased exponentially with the increase of cumulative dose of furosemide. This provides guidance for the dose of preoperative furosemide.
在冠状动脉旁路移植术（CABG）前使用呋塞米通常可改善水钠潴留。然而，目前对于呋塞米术后肾结局的研究尚未得出最终结论。我们评估了 CABG 前使用呋塞米对急性肾损伤（AKI）的影响。
我们记录了 2016 年至 2017 年期间所有接受 CABG 手术的患者术前 14 天呋塞米的使用情况。根据术前是否使用呋塞米，患者被分为呋塞米（F）组和非呋塞米（NF）组。采用 1：1 倾向评分匹配进行分析。采用多变量分析确定 CABG 后 AKI 的危险因素。
共有 974 例患者纳入研究，其中 82 例术后并发 AKI。F 组 AKI 的发生率明显高于 NF 组（28.9%比 7.4%，p=0.000）。在调整了风险因素后，F 组 AKI 的发生率是非 F 组的 5.34 倍（95%置信区间[CI] 2.45-11.64；p=0.000）。当呋塞米的累积剂量超过 110mg（比值比[OR] 6.23；95%CI 2.07-18.74，p=0.001）和 250mg（OR 8.31；95%CI 2.87-24.02，p=0.000）时，AKI 的发生率显著增加。在倾向评分匹配组分析后，也得到了相同的结果。
CABG 后 AKI 的发生与术前使用呋塞米有关，且随着呋塞米累积剂量的增加呈指数增加。这为术前呋塞米的剂量提供了指导。
