Zhang Dong, Teng Jie, Luo Zhe, Ding Xiaoqiang, Jiang Wuhua
Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
Blood Purif. 2023;52(2):166-173. doi: 10.1159/000526120. Epub 2022 Aug 26.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the most prevalent complications of cardiac surgery, while the renal and overall prognoses of chronic kidney disease (CKD) patients with CSA-AKI are extremely poor. However, there is little published information on the occurrence of CSA-AKI in patients with CKD. The purpose of this study was to investigate the risk factors and prognostic factors of cardiac surgery-related AKI in patients with CKD.
A retrospective study was performed on CKD patients who underwent cardiac surgery at a tertiary referral teaching hospital. CSA-AKI was defined based on the KDIGO criteria. The risk factors for CSA-AKI and the factors affecting renal function recovery at discharge or death in patients with AKI were investigated.
Among 1638 CKD patients enrolled, the incidence of CSA-AKI was 50.55%. AKI patients' in-hospital mortality was higher than patients without AKI (AKI vs. no AKI, 4.7 vs. 0.9%, p < 0.001). Multivariate logistic regression analysis showed that male (odds ratio [OR] 1.479), preoperative hypertension (OR 1.548), preoperative hemoglobin <110 g/L (OR 2.389), and aortic clamping time >58 min (OR 1.567) were independent risk factors for AKI after cardiac surgery in patients with CKD. Factors affecting renal function recovery of AKI patients included preoperative diabetes mellitus (OR 0.306), hyperchloremia (OR 0.927), estimate of the glomerular filtration rate (OR 1.034), and AKI progression. Compared with patients with AKI stage 1, the rate of renal function recovery in patients with AKI stage 2 and stage 3 was reduced by 78.9% and 82.3%, respectively.
In the population of patients with CKD, the incidence of CSA-AKI was high, which significantly affected renal and overall prognosis. The prompt intervention of modifiable factors may help improve the prognosis of patients with CKD.
心脏手术相关急性肾损伤（CSA-AKI）是心脏手术最常见的并发症之一，而合并CSA-AKI的慢性肾脏病（CKD）患者的肾脏及总体预后极差。然而，关于CKD患者发生CSA-AKI的公开信息很少。本研究的目的是调查CKD患者心脏手术相关急性肾损伤（AKI）的危险因素和预后因素。
对一家三级转诊教学医院接受心脏手术的CKD患者进行回顾性研究。CSA-AKI根据KDIGO标准定义。研究CSA-AKI的危险因素以及AKI患者出院时或死亡时影响肾功能恢复的因素。
在纳入的1638例CKD患者中，CSA-AKI的发生率为50.55%。AKI患者的住院死亡率高于无AKI的患者（AKI组与无AKI组，4.7%对0.9%，p<0.001）。多因素逻辑回归分析显示，男性（比值比[OR]1.479）、术前高血压（OR 1.548）、术前血红蛋白<110 g/L（OR 2.389）以及主动脉阻断时间>58分钟（OR 1.567）是CKD患者心脏手术后发生AKI的独立危险因素。影响AKI患者肾功能恢复的因素包括术前糖尿病（OR 0.306）、高氯血症（OR 0.927）、肾小球滤过率估计值（OR 1.034）以及AKI进展情况。与1期AKI患者相比，2期和3期AKI患者的肾功能恢复率分别降低了78.9%和82.3%。
在CKD患者群体中，CSA-AKI的发生率较高，这显著影响肾脏及总体预后。对可改变因素的及时干预可能有助于改善CKD患者的预后。
