术前离子镁水平与心脏手术后急性肾损伤的风险

Preoperative Ionized Magnesium Levels and Risk of Acute Kidney Injury After Cardiac Surgery.

作者信息

Koh Hee Byung, Jung Chan-Young, Kim Hyung Woo, Kwon Jae Yeol, Kim Na Hye, Kim Hyo Jeong, Jhee Jong Hyun, Han Seung Hyeok, Yoo Tae-Hyun, Kang Shin-Wook, Park Jung Tak

机构信息

Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea.

Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

出版信息

Am J Kidney Dis. 2022 Nov;80(5):629-637.e1. doi: 10.1053/j.ajkd.2022.03.004. Epub 2022 Apr 23.

DOI:10.1053/j.ajkd.2022.03.004

PMID:35469966

Abstract

RATIONALE & OBJECTIVE: Although postoperative acute kidney injury (AKI) is a serious complication after cardiac surgery, preventive measures are limited. Despite the known association of preoperative low magnesium levels with cardiac surgery-related atrial fibrillation, the association between preoperative magnesium concentration and postoperative AKI has not been fully elucidated. This study evaluated the association between preoperative serum magnesium level and the development of AKI after cardiac surgery.

STUDY DESIGN

Retrospective observational cohort study.

SETTING & PARTICIPANTS: Patients aged≥18 years who underwent cardiac surgery at 2 South Korean tertiary hospitals between 2006 and 2020 were identified from medical records. Patients with missing information, an estimated glomerular filtration rate<15mL/min/1.73m, receiving maintenance dialysis, or a history of AKI treated by dialysis within 1 year before surgery were excluded.

EXPOSURE

Preoperative serum magnesium levels.

OUTCOME

Postoperative AKI within 48 hours after surgery, defined using the Acute Kidney Injury Network (AKIN) criteria, and dialysis-treated AKI within 30 days after surgery.

ANALYTICAL APPROACH

Multivariable logistic regression analysis.

RESULTS

Among the 9,766 patients (median age, 64.0 years; 60.1% male), postoperative AKI and dialysis-treated AKI were observed in 40.1% and 4.3% patients, respectively. Postoperative AKI was more prevalent in patients with lower serum magnesium levels (44.9%, 41.4%, 39.4%, and 34.8% in quartiles 1-4, respectively). Multivariable logistic regression analysis revealed that the odds ratios (ORs) for postoperative AKI were progressively larger across progressively lower quartiles of serum magnesium concentration (adjusted ORs of 1.53 [95% CI, 1.33-1.76], 1.29 [95% CI, 1.12-1.48], 1.15 [95% CI, 1.01-1.31] for quartiles 1-3, respectively, relative to quartile 4, P for trend<0.001). Preoperative hypomagnesemia (serum magnesium level<1.09mg/dL) was also significantly associated with AKI (adjusted OR, 1.39 [95% CI, 1.10-1.77]) and dialysis-treated AKI (adjusted OR, 1.67 [95% CI, 1.02-2.72]).

LIMITATIONS

Causality could not be evaluated in this observational study.

CONCLUSIONS

Lower serum magnesium levels were associated with a higher incidence of AKI in patients undergoing cardiac surgery.

摘要

理论依据与目的

尽管术后急性肾损伤（AKI）是心脏手术后的一种严重并发症，但预防措施有限。尽管术前低镁水平与心脏手术相关的心房颤动之间的关联已为人所知，但术前镁浓度与术后AKI之间的关联尚未完全阐明。本研究评估了术前血清镁水平与心脏手术后AKI发生之间的关联。

研究设计

回顾性观察队列研究。

研究地点与参与者

从医疗记录中识别出2006年至2020年期间在韩国两家三级医院接受心脏手术的年龄≥18岁的患者。排除信息缺失、估计肾小球滤过率<15mL/min/1.73m²、接受维持性透析或术前1年内有透析治疗的AKI病史的患者。

暴露因素

术前血清镁水平。

结局指标

术后48小时内的术后AKI，采用急性肾损伤网络（AKIN）标准定义，以及术后30天内接受透析治疗的AKI。

分析方法

多变量逻辑回归分析。

结果

在9766例患者中（中位年龄64.0岁；男性占60.1%），分别有40.1%和4.3%的患者发生了术后AKI和接受透析治疗的AKI。血清镁水平较低的患者术后AKI更为常见（四分位数1 - 4分别为44.9%、41.4%、39.4%和34.8%）。多变量逻辑回归分析显示，血清镁浓度四分位数越低，术后AKI的比值比（OR）逐渐增大（相对于四分位数4，四分位数1 - 3的调整后OR分别为1.53 [95% CI，1.33 - 1.76]、1.29 [95% CI，1.12 - 1.48]、1.15 [95% CI，1.01 - 1.31]，趋势P<0.001）。术前低镁血症（血清镁水平<1.09mg/dL）也与AKI（调整后OR，1.39 [95% CI，1.10 - 1.77]）和接受透析治疗的AKI（调整后OR，1.67 [95% CI，1.02 - 2.72]）显著相关。