儿科手术后轻度急性肾损伤与长期肾功能障碍无关：一项回顾性队列研究。

Mild acute kidney injury after pediatric surgery is not-associated with long-term renal dysfunction: A retrospective cohort study.

机构信息

Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America; Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya, Turkey; Outcomes Research Consortium, Cleveland, OH, United States of America.

Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America; Department of Pediatric Anesthesia and Congenital Cardiac Anesthesia, Cleveland Clinic, Cleveland, OH, United States of America; Outcomes Research Consortium, Cleveland, OH, United States of America.

出版信息

J Clin Anesth. 2022 Dec;83:110985. doi: 10.1016/j.jclinane.2022.110985. Epub 2022 Oct 27.

DOI:10.1016/j.jclinane.2022.110985

PMID:36332365

Abstract

BACKGROUND AND STUDY OBJECTIVE

Acute kidney injury (AKI) is a sudden deterioration in renal function and is common in pediatric patients undergoing cardiac and non-cardiac surgery. Few studies have investigated the association of postoperative AKI with kidney dysfunction seen long-term and other adverse outcomes in pediatric patients. The study aimed to determine the association between postoperative AKI (mild AKI vs. no AKI and mild AKI vs. moderate-severe AKI) and chronic kidney dysfunction (CKD) seen long-term in pediatric patients undergoing cardiac and non-cardiac major surgery.

DESIGN

Restrospective, cohort study.

SETTING

Tertiary care hospital.

PATIENTS

This retrospective cohort study included patients aged 2-18 years who underwent cardiac and non-cardiac major surgery lasting >2 h at the Cleveland Clinic Main Campus between June 2005 and December 2020.

MEASUREMENTS

Postoperative AKI and CKD seen in long-term were defined and staged according to the Kidney Disease: Improving Global Outcomes criteria.

MAIN RESULTS

Among 10,597 children who had cardiac and non-cardiac major surgery, 1,302 were eligible. A total of 682 patients were excluded for missing variables and baseline kidney dysfunction and 620 patients were included. The mean age was 11 years, and 307 (49.5%) were female. Postoperative mild AKI was detected in 5.8% of the patients, while moderate-severe AKI was detected in 2.4%. There was no significant difference in CKD seen in long-term between patients with and without postoperative AKI, p = 0.83. The CKD seen in long-term developed in 27.7% of patients with postoperative mild AKI and 33.3% of patients with postoperative moderate and severe AKI. Patients without postoperative AKI had an estimated 1.09 times higher odds of having CKD seen in long-term compared with patients who have postoperative mild AKI (odds ratio [95% CI] 1.09 [0.48,2.52]).

CONCLUSION

In contrast to adult patients, the authors did not find any association between postoperative AKI and CKD seen in long-term in pediatric patients.

摘要

背景与研究目的

急性肾损伤（AKI）是肾功能的突然恶化，在接受心脏和非心脏手术的儿科患者中较为常见。很少有研究调查术后 AKI 与儿科患者长期出现的肾功能障碍和其他不良结局之间的关系。本研究旨在确定术后 AKI（轻度 AKI 与无 AKI 以及轻度 AKI 与中重度 AKI）与心脏和非心脏大手术患儿长期出现的慢性肾病（CKD）之间的关系。

设计

回顾性队列研究。

地点

三级保健医院。

患者

本回顾性队列研究纳入了 2005 年 6 月至 2020 年 12 月期间在克利夫兰诊所主校区接受持续时间超过 2 小时的心脏和非心脏大手术的 2-18 岁患者。

测量

根据肾脏病：改善全球结局（KDIGO）标准定义和分期术后 AKI 和长期出现的 CKD。

主要结果

在 10597 例接受心脏和非心脏大手术的儿童中，有 1302 例符合条件。共有 682 例因变量缺失和基线肾功能障碍而被排除，620 例被纳入。患者的平均年龄为 11 岁，307 例（49.5%）为女性。术后轻度 AKI 发生率为 5.8%，中重度 AKI 发生率为 2.4%。术后 AKI 患者与无术后 AKI 患者的长期 CKD 发生率无显著差异，p=0.83。术后轻度 AKI 患者的长期 CKD 发生率为 27.7%，术后中重度 AKI 患者的长期 CKD 发生率为 33.3%。无术后 AKI 的患者发生长期 CKD 的可能性估计比术后轻度 AKI 患者高 1.09 倍（优势比[95%CI]为 1.09 [0.48，2.52]）。