Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China.
Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China.
BMC Cardiovasc Disord. 2023 Feb 10;23(1):77. doi: 10.1186/s12872-023-03102-4.
Acute kidney injury (AKI) is a common complication after cardiac surgery, and preoperative renal dysfunction is an important risk factor. Proteinuria indicates renal structural damage, but there are few studies on proteinuria and the risk of AKI after cardiac surgery in patients with renal dysfunction. This study aimed to elucidate whether proteinuria can predict AKI after cardiac surgery in patients with renal dysfunction.
Patients with stages 3-4 chronic kidney disease (CKD) who underwent cardiac surgery were included in this retrospective study. AKI was defined according to the KDIGO criteria. The association between proteinuria and AKI in patients with CKD stages 3-4 was investigated.
The incidence of AKI in the entire cohort (n = 1546) was 53.55%. The in-hospital mortality of patients with was higher than patients without AKI (AKI vs. no AKI, 4.7 vs. 0.8%, P < 0.001). Multivariate logistic regression analysis showed that proteinuria was an independent risk factor for AKI (trace to 1+ OR 2.37; 2+ -3+ OR 5.16) and AKI requiring renal replacement therapy (AKI-RRT) (trace to 1+ OR 3.64; 2+-3+ OR 5.71). Mild proteinuria (trace to 1+ OR 2.59) was also an independent risk factor for in-hospital death. In patients with diabetes mellitus, mild proteinuria (OR 1.925), instead of severe proteinuria (2-3+), was a risk factor of AKI in patients with kidney dysfunction and diabetes.
In the population of patients with renal dysfunction, the incidence of AKI was high, which significantly compromised renal and overall prognosis. As a simple and inexpensive routine test, preoperative proteinuria still has value in predicting AKI in patients with impaired renal function.
急性肾损伤（AKI）是心脏手术后的常见并发症，术前肾功能障碍是一个重要的危险因素。蛋白尿表明存在肾脏结构损伤，但关于肾功能障碍患者的蛋白尿与心脏手术后 AKI 风险的研究较少。本研究旨在阐明蛋白尿能否预测肾功能障碍患者心脏手术后 AKI 的发生。
本回顾性研究纳入了接受心脏手术的 3-4 期慢性肾脏病（CKD）患者。AKI 根据 KDIGO 标准定义。研究了 CKD 3-4 期患者蛋白尿与 AKI 之间的关系。
整个队列（n=1546）的 AKI 发生率为 53.55%。发生 AKI 患者的住院死亡率高于未发生 AKI 患者（AKI 与无 AKI，4.7%比 0.8%，P<0.001）。多变量逻辑回归分析表明，蛋白尿是 AKI（trace 至 1+OR2.37；2+至 3+OR5.16）和 AKI 需肾脏替代治疗（AKI-RRT）（trace 至 1+OR3.64；2+至 3+OR5.71）的独立危险因素。轻度蛋白尿（trace 至 1+OR2.59）也是住院死亡的独立危险因素。在糖尿病患者中，轻度蛋白尿（OR1.925），而不是重度蛋白尿（2-3+），是肾功能障碍合并糖尿病患者 AKI 的危险因素。
在肾功能障碍患者中，AKI 的发生率较高，这显著影响了肾脏和整体预后。作为一种简单且经济的常规检查，术前蛋白尿在预测肾功能障碍患者 AKI 方面仍具有一定价值。
