Division of Nephrology, University of Michigan, Ann Arbor, Michigan.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2022 Dec;114(6):2188-2194. doi: 10.1016/j.athoracsur.2021.10.031. Epub 2021 Nov 24.
Acute kidney injury (AKI) frequently complicates cardiac surgery and is more common among Black patients. We evaluated determinants of race-based differences in AKI rates.
Serum creatinine-based criteria were used to identify adult cardiac surgical patients having postoperative AKI in the Perfusion Measures and Outcomes (PERForm) Registry (July 1, 2014, to June 30, 2019). Patient characteristics, operative details, and outcomes were compared by race (Black vs White) after excluding patients with preoperative dialysis, missing preoperative or postoperative creatinine, or other races. A mixed effects model (adjusting for demographics, comorbidities, surgical factors) used hospital as a random effect to predict postoperative stage 2 or 3 AKI. Propensity score analyses were conducted to evaluate robustness of the primary analyses.
The study cohort included 34 520 patients (8% Black). More Black patients than White patients were female (43% vs 27%, P < .001), and had hypertension (93% vs 87%, P < .001) and diabetes mellitus (51% vs 41%, P < .001). Acute kidney injury of stage 2 or greater occurred in 1697 patients (5%), more often among Black than White patients (8% vs 5%, P < .001). Intraoperatively, Black patients had lower nadir hematocrits (23 vs 26, P < .001), and were more likely to be given transfusions (22% vs 14%, P < .001). After adjustment, Black race (compared with White) independently predicted odds for postoperative AKI (adjusted odds ratio 1.50; 95% confidence interval, 1.26 to 1.78). The multivariable findings were similar in propensity score analyses.
Despite accounting for differences in risk factors and intraoperative practices, Black patients had a 50% increased odds for having moderate-severe postoperative AKI compared with White patients. Additional evaluations are warranted to identify potential targets to address racial disparities in AKI outcomes.
急性肾损伤（AKI）常并发于心脏手术，且在黑人患者中更为常见。我们评估了种族间 AKI 发生率差异的决定因素。
采用基于血清肌酐的标准，在灌注测量和结局（PERForm）登记处（2014 年 7 月 1 日至 2019 年 6 月 30 日）中识别接受心脏手术的成年患者术后 AKI。排除术前透析、术前或术后肌酐缺失或其他种族的患者后，按种族（黑人与白人）比较患者特征、手术细节和结局。使用混合效应模型（调整人口统计学、合并症、手术因素），以医院为随机效应，预测术后 2 或 3 期 AKI。进行倾向评分分析以评估主要分析的稳健性。
研究队列包括 34520 名患者（8%为黑人）。与白人患者相比，更多的黑人患者为女性（43%比 27%，P<0.001），患有高血压（93%比 87%，P<0.001）和糖尿病（51%比 41%，P<0.001）。2 期或更严重的 AKI 发生在 1697 名患者（5%）中，黑人患者比白人患者更常见（8%比 5%，P<0.001）。术中，黑人患者的最低红细胞压积较低（23 比 26，P<0.001），更有可能接受输血（22%比 14%，P<0.001）。调整后，黑人种族（与白人相比）独立预测术后 AKI 的几率（调整后的优势比 1.50；95%置信区间，1.26 至 1.78）。倾向评分分析中的多变量结果相似。
尽管考虑了危险因素和术中操作的差异，但与白人患者相比，黑人患者术后发生中度至重度 AKI 的几率增加了 50%。需要进一步评估以确定潜在的目标，以解决 AKI 结局中的种族差异。
