Guangyu Yan, Jingfeng Lou, Xing Liu, Hong Yuan, Yao Lu
Center of Clinical Research, The Third Xiangya Hospital, Central South University, Changsha, China.
Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China.
Front Pharmacol. 2021 Aug 27;12:696456. doi: 10.3389/fphar.2021.696456. eCollection 2021.
The cardiovascular and cerebrovascular risk of postoperative acute kidney injury (AKI) in surgical patients is poorly described, especially in the hypertensive population. : We conducted a retrospective cohort study among all hypertensive patients who underwent elective noncardiac surgery from January 1st, 2012 to August 1st, 2017 at the Third Xiangya Hospital. The primary outcomes were fatal stroke and fatal myocardial infarction (MI). The secondary outcomes were all-cause mortality. The postoperative cumulative mortality within 3 months, 6 months, 1 year, 2 years, and 5 years were 1.27, 1.48, 2.15, 2.15, and 5.36%, for fatal stroke, and 2.05, 2.27, 2.70, 3.37, and 5.61% for fatal MI, respectively, in patients with postoperative AKI. Compared with non-AKI patients, those with postoperative AKI had a significantly higher risk of fatal stroke and fatal MI within 3 months [hazard ratio (HR): 5.49 (95% CI: 1.88-16.00) and 11.82 (95% CI: 4.56-30.62), respectively], 6 months [HR: 3.58 (95% CI: 1.43-8.97) and 9.23 (95% CI: 3.89-21.90), respectively], 1 year [HR: 3.64 (95% CI: 1.63-8.10) and 5.14 (95% CI: 2.50-10.57), respectively], 2 years [HR: 2.21 (95% CI: 1.03-4.72) and 3.06 (95% CI: 1.66-5.64), respectively], and 5 years [HR: 2.27 (95% CI: 1.30-3.98) and 1.98 (95% CI: 1.16-3.20), respectively]. In subgroup analysis of perioperative blood pressure (BP) lowering administration, postoperative AKI was significantly associated with 1-year and 5-year risk of fatal stroke [HR: 9.46 (95% CI: 2.85-31.40) and 3.88 (95% CI: 1.67-9.01), respectively] in patients with ACEI/ARB, and MI [HR: 6.62 (95% CI: 2.23-19.62) and 2.44 (95% CI: 1.22-4.90), respectively] in patients with CCB. Hypertensive patients with postoperative AKI have a significantly higher risk of fatal stroke and fatal MI, as well as all-cause mortality, within 5 years after elective noncardiac surgery. In patients with perioperative administration of ACEI/ARB and CCB, postoperative AKI was significantly associated with higher risk of fatal stroke and MI, respectively.
手术患者术后急性肾损伤（AKI）的心血管和脑血管风险描述甚少，尤其是在高血压人群中。我们对2012年1月1日至2017年8月1日在湘雅三医院接受择期非心脏手术的所有高血压患者进行了一项回顾性队列研究。主要结局为致命性卒中及致命性心肌梗死（MI）。次要结局为全因死亡率。术后发生AKI的患者3个月、6个月、1年、2年和5年的术后累积死亡率，致命性卒中分别为1.27%、1.48%、2.15%、2.15%和5.36%，致命性MI分别为2.05%、2.27%、2.70%、3.37%和5.61%。与未发生AKI的患者相比，术后发生AKI的患者在3个月内发生致命性卒中和致命性MI的风险显著更高[风险比（HR）分别为5.49（95%CI：1.88 - 16.00）和11.82（95%CI：4.56 - 30.62）]、6个月时[HR分别为3.58（95%CI：1.43 - 8.97）和9.23（95%CI：3.89 - 21.90）]、1年时[HR分别为3.64（95%CI：1.63 - 8.10）和5.14（95%CI：2.50 - 10.57）]、2年时[HR分别为2.21（95%CI：1.03 - 4.72）和3.06（95%CI：1.66 - 5.64）]以及5年时[HR分别为2.27（95%CI：1.30 - 3.98）和1.98（95%CI：1.16 - 3.20）]。在围手术期血压（BP）降低给药的亚组分析中，术后AKI与接受血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂（ACEI/ARB）治疗的患者1年和5年致命性卒中风险显著相关[HR分别为9.46（95%CI：2.85 - 31.40）和3.88（95%CI：1.67 - 9.01）]，与接受钙通道阻滞剂（CCB）治疗的患者MI风险显著相关[HR分别为6.62（95%CI：2.23 - 19.62）和2.44（95%CI：1.22 - 4.90）]。择期非心脏手术后5年内，术后发生AKI的高血压患者发生致命性卒中和致命性MI以及全因死亡的风险显著更高。在围手术期接受ACEI/ARB和CCB治疗的患者中，术后AKI分别与更高的致命性卒中和MI风险显著相关。
